peper 2008

Q 1: Dermatological diagnosis

Ans: Melanoma

Q 2: Caused by androgenic stimulation of genetically predisposed sebaceous glands

Ans: Acne

Q 3: Dermatological diagnosis of this infection

Ans: Herpes simplex

Q 4: Dermatological condition associated with celiac disease

Ans: Dermatitis herpetiformis

Q 5: Disease associated with "corkscrew hairs"

Ans: Scurvy
Q 6: Drug of choice to prevent altitude sickness
Ans: Acetazolamide

Q 7: Best tidal volume for mechanical ventilation treatment of ARDS

Ans: 6 mL/kg idea body weight

Q 8: Genetic disease suggested by this radiograph

Ans: Alpha-1-antitrypsin deficiency

Q 9: Reduces risk of air embolism during central venous catheter removal

Ans: Trendelenburg position or Valsalva (either)

Q 10: Disease with chest CT findings described as "crazy paving"

Ans: Pulmonary alveolar proteinosis

Q 11: Essential serological finding in rheumatoid vasculitis

Ans: High titers of rheumatoid factor (accept rheumatoid factor)

Q 12: Syndrome of chelitis, dry mouth, and trouble chewing and swallowing food
Ans: Xerostomia (Sjögren's syndrome)

Q 13: Rheumatologic diagnosis

Ans: Rheumatoid arthritis

Q 14: Cause of upper airway obstruction in rheumatoid arthritis

Ans: Cricoarytenoid arthritis

Q 15: Most common extra-articular manifestation of ankylosing spondylitis

Ans: Acute anterior uveitis

Q 16: Immunoglobulin involved in anaphylactic reaction

Ans: IgE

Q 17: Chronic treatment for symptomatic common variable immunodeficiency

Ans: Gamma globulin replacement therapy

Q 18: Inheritance pattern of hereditary angioedema

Ans: Autosomal dominant

Q 19: Preferred treatment for acute episodes of angioedema in hereditary angioedema

Ans: C1-INH (inhibitor) concentrate (accept danazol or stanzolol)

Q 20: Disease associated with "corkscrew hairs"

Ans: Scurvy

Q 21: Most likely cancer in a young, non-smoking female with adenocarcinoma in

axillary lymph node
Ans: Breast cancer

Q 22: Increased risk of this malignancy in patients taking tamoxifen

Ans: Endometrial cancer (uterine)

Q 23: Metastatic solid tumor cured with bleomycin, etoposide, and cisplatin
Ans: Testicular carcinoma

Q 24: Cancer most frequently associated with tumor marker CA 19-9

Ans: Pancreas

Q 25: Treatment for recurrent gastric MALT lymphoma

Ans: Chemotherapy or gastrectomy (either)
Q 26: Psychiatric side effect associated with interferon alpha
Ans: Depression

Q 27: Syndrome associated with enamel erosions on the inner surfaces of the teeth
Ans: Bulimia

Q 28: Dosing scheme that reduces total benzodiazepine dose during inpatient treatment
of alcohol withdrawal
Ans: Symptom-triggered

Q 29: Syndrome of 8 unexplained symptoms, including pain, gastrointestinal, sexual,

and neurologic
Ans: Somatization disorder

Q 30: Neurological condition that contraindicates use of bupropion

Ans: Seizure

Q 31: The probability of disease in the presence of a positive test

Ans: Positive predictive value

Q 32: Strong risk factor for the development of erythroplakia

Ans: Chewing tobacco

Q 33: Number needed in order to calculate the number needed to treat (NNT)
Ans: Absolute rate (risk) reduction

Q 34: Best end-point for measuring the effect of a cancer screening intervention
Ans: Cause specific mortality (cancer mortality accepted)

Q 35: Observational studies suggest that screening mammography is useful in women

who have at least this number of years of life expectancy
Ans: 5 years (accept 3-7)

Q 36: Two most common causes of mucopurulent cervicitis

Ans: Chlamydia trachomatis and Neisseria gonorrhoeae

Q 37: Diagnosis suggested by vaginal discharge with "fishy" odor, vaginal irritation, and
vaginal pH of 5
Ans: Bacterial vaginosis

Q 38: Diagnosis characterized by cyclical pelvic pain and dyspareunia

Ans: Endometriosis
Q 39: Diffuse white plaque like areas on the vulva associated with chronic pruritus
Ans: Lichen simplex chronicus

Q 40: Diagnosis suggested by dyspareunia and punctate ulcers in the vestibule located
primarily around the Bartholin's glands
Ans: Vulvar vestibulitis

Q 41: Treatment of choice for mild persistent asthma during pregnancy

Ans: Inhaled corticosteroid

Q 42: Best position to increase venous return in hypotensive, pregnant female

Ans: Left lateral decubitus

Q 43: Treatment of choice for pregnant patient with Chlamydia cervicitis

Ans: Erythromycin or amoxicillin (either)

Q 44: Treatment for asymptomatic gravida 1, para 0, ab 0 patient with positive

antiphospholipid antibodies
Ans: No treatment

Q 45: Pregnancy complication of untreated Trichomonas vaginitis

Ans: Premature rupture of membranes or preterm delivery (either)

Q 46: Term for weight of urine compared to weight of distilled water

Ans: Specific gravity

Q 47: Diagnosis associated with this urine microscopic finding

Ans: Glomerulonephritis
Q 48: Most likely cause of hyperkalemia in diabetic patients with mild to moderate renal
insufficiency
Ans: Hyporeninemic hypoaldosteronism (accept type IV RTA)

Q 49: This hematological laboratory finding in chronic kidney disease is an independent

predictor of left ventricular hypertrophy
Ans: Anemia

Q 50: Acid-base disorder associated with hypocitraturia

Ans: Metabolic acidosis

Q 51: Recommended treatment for chronic hepatitis C infection

Ans: Pegylated interferon and ribavirin

Q 52: Acne treatment that requires two forms of contraception and monthly pregnancy
testing during treatment
Ans: Isotretinoin

Q 53: Anticonvulsant drug associated with metabolic bone disease

Ans: Phenytoin

Q 54: Symptomatic treatment for erythromelalgia

Ans: Aspirin

Q 55: Effective, non-steroid topical treatment for severe, recalcitrant eczema

Ans: Topical tacrolimus

Q 56: Radiographic finding of the subperiosteum associated with excessive secretion of

parathyroid hormone
Ans: Subperiosteal bone resorption

Q 57: Category of disease responsible for skin findings

Ans: Leukocytoclastic vasculitis (accept vasculitis)

Q 58: Most common cause of heel pain

Ans: Plantar fasciitis

Q 59: Name of skin condition found on this patient with Reiter's syndrome
Ans: Keratoderma blennorrhagicum
Q 60: Syndrome characterized by pain localized to the distal radius and a positive
Finkelstein's test
Ans: De Quervain's tenosynovitis

Q 61: Syndrome of esophageal webs and iron deficiency anemia

Ans: Plummer-Vinson syndrome (Patterson-Kelly syndrome)

Q 62: Hypopharyngeal condition associated primarily with postprandial throat clearing

and production of liquid and food particles and episodes of aspiration
Ans: Zenker's diverticulum

Q 63: Diagnosis responsible for this common upper endoscopy finding

Ans: GERD (accept esophagitis)

Q 64: In patients with esophageal cancer, preferred non-invasive diagnostic test to

determine extent of disease progression within esophageal wall and regional lymph
nodes
Ans: Endoscopic ultrasonography

Q 65: A cause of dysphagia that can be relieved in some patients by lifting their arms
over the heads or with a Valsalva maneuver
Ans: Achalasia

Q 66: This syndrome is characterized by softening of the nailbed and obliteration of the
15-degree angle between proximal nailbed and the dorsal aspect of the distal phalanx
Ans: Clubbing of the nailbed
Q 67: Name of pulse associated with aortic insufficiency
Ans: Corrigan's pulse (or water hammer pulse)

Q 68: Name of pulse characteristically associated with hypertrophic cardiomyopathy

Ans: Bisferiens pulse

Q 69: Name of physical finding associated with an increase in jugular venous pressure
on inspiration
Ans: Kussmaul's sign

Q 70: Eponym applied to physical examination sign describing an increased intensity of

a heart murmur during inspiration
Ans: Carvallo's sign

Q 71: Prerequisite pulmonary function test finding prior to bronchoprovocation testing

with methacholine
Ans: Normal baseline spirometry

Q 72: Condition associated with flattening of the inspiratory and expiratory limbs of the
flow volume loop
Ans: Fixed upper airway obstruction

Q 73: The earliest pleural manifestation of asbestos exposure

Ans: Benign asbestos related pleural effusion

Q 74: Neck circumference measurement associated with an increased risk of obstructive

sleep apnea
Ans: > 17 inches (43 cm)

Q 75: A hematological disorder that is associated with periodic limb movement disorder
(PLMD)
Ans: Iron deficiency
Q 76: Skeletal finding on chest x-ray in patient with aortic coarctation
Ans: Rib notching

Q 77: Echocardiogram diagnosis

Ans: Pericardial effusion

Q 78: Valvular abnormality associated with familial hypercholesterolemia

Ans: Calcific aortic stenosis

Q 79: Recommendation for patients with primary pulmonary hypertension who become
pregnant
Ans: Termination of pregnancy

Q 80: The ejection fraction or systolic left ventricle internal diameter used as in
indication for surgical intervention in severe mitral regurgitation
Ans: Left ventricular ejection fraction < 60% or left ventricular internal diameter is
systole > 45 mm

Q 81: This boy was treated for hypovolemia, hyponatremia and hyperkalemia.

Ans: Addisons disease

Q 82: Changes in LDL concentration in patients treated for subclinical hypothyroidism

(normal T4, elevated TSH)
Ans: Reduction in LDL (accept improved)

Q 83: Imaging test that will distinguish between postpartum thyroiditis and Graves
disease
Ans: 24-Hour radioactive iodine uptake

Q 84: Non-insulin hormone responsible for storing body fat

Ans: Leptin

Q 85: Severe hypertension, metabolic acidosis, hypokalemia and suppressed plasma

renin activity and plasma aldosterone
Ans: Liddle's syndrome

Q 86: First priority in assessing a possible case of domestic violence

Ans: Assess patient safety

Q 87: Vaginitis diagnosis based upon this wet mount

Ans: Candida vaginitis

Q 88: Best treatment for low-grade squamous intraepithelial lesion discovered on Pap
smear
Ans: Colposcopy and biopsy

Q 89: In 50% of women with contraceptive associated hypertension, the blood pressure
will return to normal within this time span
Ans: 3 months

Q 90: Generalized urticaria, dyspnea, cardiovascular collapse in a woman a few minutes

after coitus
Ans: Anaphylaxis to seminal fluid or latex

Q 91: Dermatologic diagnosis

Ans: Aphthous ulcer

Q 92: Dermatological nail diagnosis

Ans: Psoriasis

Q 93: Diagnosis of this generally asymptomatic condition

Ans: Tinea versicolor (pityriasis versicolor)

Q 94: Condition that predisposes to skin necrosis in patients started on warfarin without
heparin
Ans: Protein C deficiency
Q 95: Skin condition associated with inflammatory bowel disease but whose activity
does not parallel that of the bowel disease
Ans: Pyoderma grangrenosum

Q 96: Ophthalmological diagnosis for patient with minor symptoms

Ans: Conjuctivitis

Q 97: Test for lacrimal function in patients with dry eyes

Ans: Schirmer test

Q 98: Most likely diagnosis responsible for this visual field defect

Ans: Pituitary mass

Q 99: Proliferation of opaque fibrovascular conjunctival tissue medial to iris

Ans: Pterygium

Q 100: Ophthalmologic diagnosis

Ans: Malignant hypertension

Q 101: Cause of "machinery murmur"

Ans: Patent ductus arteriosus (PDA)

Q 102: Murmur associated with this condition is harsh, systolic, diamond-shaped, and
increases in intensity with Valsalva
Ans: Hypertrophic cardiomyopathy (accept ASH or IHSS)

Q 103: Literal meaning of parvus et tardus

Ans: Small and late

Q 104: Life-long, loud systolic murmur heard best along the left sternal border
associated with a thrill and a normal carotid upstroke, jugular pulsation, chest x-ray,
and ECG
Ans: (Small) Ventricular septal defect

Q 105: Name for head bobbing during systole in aortic insufficiency

Ans: de Musset's sign

Q 106: Initial treatment of cerumen impaction that completely occludes the ear canal
Ans: Ceruminolytic (Ceruminex)
Q 107: Term to describe rebound swelling of nasal mucosa after vasoconstricting effects
of topical medication wears off
Ans: Rhinitis medicamentosa

Q 108: Type of hearing loss associated with a Weber test that lateralizes away from the
deaf ear
Ans: Sensorineural hearing

Q 109: Non-drug treatment for benign positional vertigo

Ans: Otolith repositioning maneuver

Q 110: Nasal mucosal atrophy and foul-smelling crusts in the nasal passages
Ans: Ozena

Q 111: Nobel awardee for development of electrocardiogram

Ans: Willem Einthoven

Q 112: First to provide experimental proof that blood was pumped through a closed
circulatory system
Ans: William Harvey

Q 113: The 1910 report that revolutionized medical education and established current
system of education
Ans: Flexner Report

Q 114: First to use mecury in a thermometer to measure temperature

Ans: Gabreil Daneil Fahrenheit

Q 115: Persian physician who gave first accurate description of measles and smallpox
Ans: Rhazes (Razi)

Q 116: Recommended therapy for a patient with rheumatoid arthritis who develops
interstitial pulmonary fibrosis associated with methotrexate therapy
Ans: Stop the methotrexate

Q 117: Name of disease associated with this painful lesion on the anterior leg and hilar
lympadenopathy
Ans: Sarcoidosis

Q 118: Syndrome of pulmonary rheumatoid nodules in patient with co-existing coal

worker's pneumoconiosis
Ans: Caplan's syndrome

Q 119: Interstitial lung disease characterized by upper lobe masses in patient with
known silicosis
Ans: Progressive massive fibrosis

Q 120: Slowly progressive pulmonary syndrome associated with cystic changes in the
lungs occurring almost exclusively in smokers
Ans: Pulmonary Langerhan's cell histiocytosis (eosinophilic granuloma or histiocytosis X)

Q 121: This laboratory result helps identify surreptitious insulin administration from an
insulinoma as a cause of hypoglycemia
Ans: Low serum C-peptide

Q 122: Syndrome characterized by clinical and biochemical evidence of thyrotoxicosis,

low 24-hour radioactive iodine uptake, nontender thyroid gland, and normal
sedimentation rate
Ans: Silent (lymphocytic) thyroiditis or factitious (exogenous) thyrotoxicosis

Q 123: Most common manifestation of Multiple Endocrine Neoplasia type 1 (MEN-1)

Ans: Parathyroid disease (or hyperparathyroidism)

Q 124: Endocrine condition associated with this finding

Ans: Retrosternal thyroid gland

Q 125: This hormone deficiency is associated with Kallmann's syndrome

Ans: Gonadatropin-releasing hormone

Q 126: Most frequent cause of transient aplastic crisis in patients with chronic hemolytic
anemia
Ans: Parvovirus B19 infection

Q 127: Major use of cryoprecipitate is to replace this blood component

Ans: Fibrinogen

Q 128: Most common enzyme deficiency associated with these red blood cells

Ans: Glucose 6-phosphate deficiency

Q 129: Important cause of recurrent abdominal pain in patients with paroxysmal

nocturnal hemoglobinuria
Ans: Portal or mesenteric thrombosis

Q 130: Disease associated with "sausaging" of retinal veins

Ans: Macroglobulinemia (accept Waldenstrom's, hyperviscosity syndrome)

Q 131: Common tremor that is primarily action, but does have a postural component
Ans: Essential tremor

Q 132: Dementing syndrome characterized by very rapid course, rigidity, ataxia, and
myoclonus
Ans: Creutzfeldt-Jakob
Q 133: Name of condition characterized by rapidly flowing, dancing-like involuntary
movements occurring in a chaotic, nonstereotypic fashion
Ans: Chorea

Q 134: Syndrome characterized by frequent falls and vertical gaze paralysis

Ans: Progressive supranuclear palsy (or, Parinaud's syndrome)

Q 135: Syndrome characterized by dysautonomia, Parkinson's symptoms, corticospinal

tract signs, and ataxia
Ans: Multiple system atrophy

Q 136: Diagnosis of this skin condition

Ans: Erythema multiforme

Q 137: Diagnosis of painful lesion on anterior leg

Ans: Erythema nodosum

Q 138: Name this potentially lethal skin condition

Ans: Toxic epidermal necrolysis

Q 139: Rash on sun exposed skin

Ans: Discoid lupus

Q 140: Diagnosis for patient with fever, arthralgias and this painful plaque
Ans: Sweet's syndrome (acute febrile neutrophilic dermatosis)

Q 141: Psychiatric disorder occurring commonly following stroke

Ans: Depression

Q 142: Syndrome characterized by hypokalemic metabolic alkalosis, mild hypotension,

mild hypothermia, calluses on the knuckles and enamel erosion
Ans: Bulimia nervosa

Q 143: Most common psychiatric disorder in women over the age of 65 years
Ans: Generalized anxiety disorder

Q 144: Name of syndrome characterized by agitation, altered mental status, nausea,

vomiting, diarrhea, dizziness, hypotension, fever, shivering and diaphoresis in a patient
taking an SSRI and lithium
Ans: Serotonin syndrome

Q 145: Syndrome characterized by the presence of four or more unexplained symptoms

Ans: Abridged somatization

Q 146: The autoantibody most closely associated with Wegener's granulomatosis

Ans: Antineutrophil cytoplasmic antibodies (or C-ANCA)

Q 147: Rheumatological diagnosis associated with ANA autoantibody

Ans: Dermatomyositis

Q 148: Antibodies associated with systemic sclerosis

Ans: Anti-Scl-70 or anticentromere antibodies (either)

Q 149: This antibody is associated with the absence of interstitial lung disease in
patients with scleroderma
Ans: Anticentromere antibody

Q 150: Myositis specific autoantibodies associated with interstitial lung disease, arthritis,
and a hyperkeratotic rash on the hands
Ans: Antihistidyl-tRNA synthetase

Q 151: Bacterial agent causing pneumonia associated with the following risk factors:
bronchiectasis, daily corticosteroid therapy, and malnutrition
Ans: Pseudomonas

Q 152: Infection characterized by productive cough, hemoptysis, and cavitary

pulmonary lesion in a patient with pulmonary silicosis
Ans: Tuberculosis

Q 153: Diagnosis suggested by a severe community acquired pneumonia with

pancytopenia in the setting of bird exposures
Ans: Psittacosis

Q 154: Class of drug useful in the treatment of both influenza A and influenza B
Ans: Neuraminidase inhibitors (zanamivir and oseltramivir)

Q 155: Preferred first-line antibiotic for the pneumonic form of tularemia

Ans: Gentamicin (or streptomycin)

Q 156: Syndrome characterized by rapidly progressive glomerulonephritis and

circulating antibody against glomerular basement membrane
Ans: Goodpasture's syndrome

Q 157: Mechanism of an infection-associated glomerulonephritis and renal injury

Ans: Immune complex deposition
Q 158: Syndrome characterized by joint pain, abdominal pain, palpable purpura, and a
nephritic sediment
Ans: Henoch-Schonlein purpura

Q 159: Solid tumors such as colon cancer, lung cancer, breast cancer, and gynecologic
cancers are associated predominantly with this histological type of glomerular disease
Ans: Membranous nephropathy

Q 160: Second most common cause of nephrotic syndrome in adults

Ans: Diffuse lupus nephritis

Q 161: Most common acute gastrointestinal complication of radiation therapy for

prostate cancer
Ans: Acute proctitis

Q 162: Relative effect of beta-carotene given prophylactically to prevent lung cancer

Ans: Increased incidence and mortality (either)

Q163: Syndrome is associated with these findings (A is current photograph, B is

photograph 5 years previously, C is current photograph of upper chest)

Ans: Superior vena cava syndrome

Q 164: This treatment is indicated for patients with recurrent MALT lymphoma
Ans: Chemotherapy or gastrectomy (either)

Q 165: New class of hormonal agent found to be superior to tamoxifen in treating

metastatic breast cancer and as adjuvant therapy for early stage breast cancer
Ans: Third generation aromatase inhibitors (i.e., letrozole)
Q 166: LDL cholesterol goal for a patient with an abdominal aortic aneurysm
Ans: < 100 mg/dL

Q 167: Diagnosis accounting for these acutely painful toes following coronary
catherization

Ans: Cholesterol emboli

Q 168: A vascular condition associated with bicuspid aortic valves that may require
surgical intervention
Ans: Enlargement of ascending aorta

Q 169: A vital sign that may be unreliable to obtain by usual methods in patients with
Takayasu's arteritis
Ans: Blood pressure

Q 170: This drug is more effective then pentoxifylline in improving walking distance,
functional status, and quality of life for patients with claudication
Ans: Cilostazol

Q 171: Ethical obligation to assess and manage this symptom that occurs commonly at
end-of-life
Ans: Pain
Q 172: Group that provides an independent review of research projects to assure
reasonableness, validity, importance, and protection of subjects
Ans: Institutional Review Board (IRB)

Q 173: Participation by physicians in this government sanctioned activity is unethical

except to certify death
Ans: Execution

Q 174: Name applied to decision making for a patient whose preferences are not known
but are based upon the best evidence of what the patient would have wanted
Ans: Substituted judgment

Q 175: Federal law requiring health care institutions participating in Medicare/Medicaid

to ask if a patient has an advance directive, to provide information about advance
directives, and incorporate advance directives into the medical record
Ans: Patient Self-Determination Act of 1990

Q 176: A common benign cause of congenital indirect hyperbilirubinemia

Ans: Gilbert's syndrome

Q 177: Diagnosis suggested by cholestatic biochemical pattern in a patient with

inflammatory bowel disease
Ans: Sclerosing cholangitis

Q 178: Syndrome found in middle-aged women characterized by cholestatic laboratory

findings, significantly elevated alkaline phosphatase, and pruritus
Ans: Primary biliary cirrhosis

Q 179: Syndrome characterized by intestinal obstruction and pneumobilia

Ans: Gallstone ileus

Q 180: Syndrome characterized by narrowing of the extra-hepatic bile duct from

mechanical compression by a gallstone impacted in the cystic duct
Ans: Mirizzi's syndrome
peper 2009
Q 1: First-line treatment for acute urticaria
Ans: Antihistamines

Q 2: Anaphylaxis due to food allergy is mediated by this antibody

Ans: IgE

Q 3: Diagnosis associated with hypogammaglobulinemia and recurrent sinopulmonary

infections
Ans: Common variable immunodeficiency

Q 4: Hereditary condition suggested by genital edema in a child after riding a bicycle

Ans: Hereditary angioedema

Q 5: Recommended prophylaxis for patients with chronic granulomatous disease

Ans: Trimethoprim/sufamethoxazole plus interferon

Q 6: Disease associated with erythema chronicum migrans

Ans: Lyme disease

Q 7: Major complication associated with recombinant human activated protein C

Ans: Bleeding

Q 8: Adjuvant treatment to prevent severe pain associated with herpes zoster

Ans: Prednisone

Q 9: Duration of treatment for cutaneous anthrax

Ans: 60 days

Q 10: Diagnosis suggested by muscle spasms provoked by gentle blowing onto the face
Ans: Rabies

Q 11: Diagnostic test to confirm amyotrophic lateral sclerosis

Ans: Electromyography

Q 12: Nerve root impingement producing absent Achilles reflex

Ans: S1 nerve root

Q 13: Other than allergy, absolute contraindication to triptan and ergotamine use
Ans: Coronary artery disease (angina)

Q 14: Progressive impairment of cognition with prominent personality and behavior

changes
Ans: Frontotemporal dementia

Q 15: LDL cholesterol below 70 mg/dL is associated with this adverse outcome
Ans: Hemorrhagic stroke

Q 16: Upper airway complication of prolonged intubation

Ans.Tracheal stenosis(or tracheomalacia)

Q 17: MRI of brainstem following treatment with hypertonic saline for symptomatic
hyponatremia

Ans: Central pontine myelinolysis

Q 18: Syndrome characterized by quadriplegia, paralysis of horizontal eye movements

with preservation of vertical eye movements, and inability to speak
Ans: Locked-in syndrome

Q 19: Most likely cause of failure to wean a patient who received neuromuscular
blocking agents to facilitate mechanical ventilation
Ans: Persistent neuromuscular blockade or acute myopathy
Q 20: Smoke inhalation victim with coma, hypotension, profound anion-gap metabolic
acidosis unresponsive to volume replacement and oxygen
Ans: Cyanide poisoning

Q 21: Class of anti-influenza drugs with activity against influenza B

Ans: Neuraminidase inhibitors

Q 22: The two most common bacterial pathogens associated with bronchiectasis
Ans: Pseudomonas and Staphylococcus

Q 23: Name of childhood illness caused by parvovirus B 19

Ans: Erythema infectiosum (fifth disease)

Q 24: Etiological agent of fish tank granuloma

Ans: Mycobacterium marinum

Q 25: Cutaneous anthrax location that is an indication for IV antibiotics

Ans: Face and neck

Q 26: Oliguria, normal urine sediment and a fractional excretion of sodium less than
1.0%
Ans: Prerenal azotemia (any answer consistent with decreased effective vascular
volume)

Q 27: Diagnosis associated with hypokalemia and metabolic alkalosis

Ans: Diuretic use or vomiting or Bartter's syndrome (any)

Q 28: Biological drug for acute renal failure secondary to hepatitis C associated
cryoglobulinemia
Ans: alpha-Interferon

Q 29: Hormone results in regression of left ventricular hypertrophy in dialysis patients

Ans: Recombinant human erythropoietin

Q 30: Creatinine, sex, and age-based formula to estimate glomerular filtration rate
Ans: Cockcroft-Gault formula (any part of name)
Q 31: Most likely diagnosis associated with hypercalcemia and osteoporosis
Ans: Primary hyperparathyroidism

Q 32: Sign associated with contraction of the facial muscles after tapping facial nerve
Ans: Chvostek's sign

Q 33: Hyperglycemia resulting from morning surge in cortisol and growth hormone
Ans: Dawn phenomenon

Q 34: Disease associated with necrolytic migratory erythema

Ans: Glucagonoma

Q 35: Metabolic disease that is associated with patient smelling like putrid fish
Ans: Trimethylaminuria

Q 36: Class of drugs causing regression of polyps in familial adenomatous polyposis

Ans: Nonsteroidal anti-inflammatory drugs

Q 37: Esophageal diagnosis associated with radiographic "bird's beak" sign

Ans: Achalasia

Q 38: Typical location of perforation in acute idiopathic intestinal obstruction

Ans: Cecum

Q 39: Non-hepatic cause of elevated indirect bilirubin in Wilson's disease

Ans: Hemolysis

Q 40: Sudden loss of vision associated with hemorrhages confined to the optic disk and
macula in acute pancreatitis
Ans: Purtscher's retinopathy

Q 41: Best therapy for acute chest syndrome associated with sickle cell disease
Ans: Partial-exchange transfusion (transfusion acceptable)

Q 42: Hematological diagnosis classically associated with pica and pallor

Ans: Iron deficiency anemia

Q 43: Most common cause of mild, asymptomatic thrombocytopenia in pregnancy

Ans: Gestational thrombocytopenia
Q 44: Best test for paroxysmal nocturnal hemoglobinuria
Ans: Flow cytometry

Q 45: Drug for acute aplastic anemia

Ans: Antithymocyte globulin or cyclosporin (either)

Q 46: Diagnosis associated with anovulatory uterine bleeding, hirsutism, and obesity
Ans: Polycystic ovary syndrome

Q 47: Common diagnosis causing chronic, heavy menstrual bleeding with varying cycle
length
Ans: Anovulatory bleeding

Q 48: Breast cancer prediction model based upon personal and family risk factors
Ans: Gail model

Q 49: Vulvar lichen sclerosis predisposes to this malignant condition

Ans: Vulvar squamous cell carcinoma

Q 50: Dermatological condition causing vulvar itching, edema, skin thickening, and
erythema
Ans: Lichen simplex chronicus

Q 51: Medical treatment for mild to moderate salicylate intoxication

Ans: Alkalinization of the urine

Q 52: Group of toxins that can produce an elevated osmolal gap

Ans: Alcohols

Q 53: Treatment of choice for severe carbon monoxide toxicity with coma
Ans: Hyperbaric oxygen

Q 54: Alcohol poisoning associated with increased osmolar gap but a normal anion gap
Ans: Isopropyl alcohol

Q 55: Name of nomogram used to determine probability of acetaminophen toxicity

Ans: Rumack-Matthew nomogram

Q 56: Mechanism of supine hypotensive syndrome of pregnancy

Ans: Compression the inferior vena cava or the aorta by uterus (either answer)
Q 57: Best trimester to perform "semi-elective" abdominal surgery
Ans: Second trimester

Q 58: Normal PCO2 level during pregnancy

Ans: 28-32 mm Hg (accept any answer within range)

Q 59: Major fetal effect of maternal ACE inhibitor use

Ans: Renal tubular dysgenesis

Q 60: Pregnancy complication of untreated Trichomonas vaginitis

Ans: Premature rupture of membranes or preterm delivery (either answer)

Q 61: Diagnosis of this acute painful skin eruption

Ans: Herpes zoster

Q 62: Dermatological diagnosis of painful finger lesions

Ans: Cutaneous infarctions (accept vasculitis and emboli)
Q 63: Dermatological diagnosis

Ans: Basal cell carcinoma

Q 64: Diagnosis based upon scraping from skin lesion

Ans: Tinea versicolor (pityriasis versicolor)

Q 65: Diagnosis for this itchy condition

Ans: Scabies

Q 66: Most common neurological complication of systemic cancer

Ans: Brain metastases

Q 67: Treat this cancer in a woman with adenocarcinoma of unknown primary and
diffuse peritoneal metastases
Ans: Ovarian cancer

Q 68: Serum marker that is unique for nonseminomatous testicular cancer

Ans: Alpha-fetoprotein

Q 69: Relapsing fever of Hodgkin's disease

Ans: Pel-Ebstein fever

Q 70: Test used to screen for anal intraepithelial neoplasia in high risk patients
Ans: Pap smear

Q 71: Term for conjunctival edema

Ans: Chemosis
Q72: Ophthalmologic diagnosis in a HIV patient

Ans: Cytomegalic retinitis

Q 73: Primary ophthalmological finding

Ans: Papilledema

Q 74: Painful and serious ophthalmologic diagnosis

Ans: Sclertitis

Q 75: Disease associated with corkscrew conjunctival vessels

Ans: Sickle cell disease
Q 76: Oliguria, red blood cell casts, and a fractional excretion of sodium less than 1.0%
Ans: Glomerulonephritis

Q 77: Syndrome of hematuria, bilateral abdominal masses, and renal failure

Ans: Autosomal dominant polycystic kidney disease (or polycystic kidney disease)

Q 78: Personal habit that increases the risk of IgA nephropathy progressing to end-
stage renal failure
Ans: Smoking

Q 79: In addition to red blood cell casts, microscopic finding confirms the diagnosis of
glomerulonephritis
Ans: Dysmorphic red blood cells

Q 80: Name of this crystal found in the urine

Ans: Struvite crystals (triple phosphate)

Q 81: Cardiac auscultatory finding associated with acute ischemia that disappears with
relief of the ischemia
Ans: Mitral regurgitant murmur (accept holosystolic murmur), paradoxical splitting of
S2, and an S4 (any one answer accepted)

Q 82: Phase of respiration when pericardial friction rubs are best heard
Ans: Inspiration

Q 83: Paraumbilical node associated with intraabdominal or pelvic neoplasm

A: Sister Joseph's node (Sister Mary Joseph's node also acceptable

Q 84: Shortness of breath in the erect position

Ans: Platypnea

Q 85: Respiratory problem associated with yellow nail syndrome

Ans: Pleural effusion OR bronchiectasis OR sinusitis

Q 86: Typical location of bullae in patients with alpha-1- antitrypsin deficiency

Ans: Lower chest

Q 87: Laryngeal finding associated with vocal cord dysfunction

Ans: Adduction of vocal cords (or paradoxical motion of vocal cords)

Q 88: Inhaled drug that is effective for bronchoconstriction due to propranolol

Ans: Ipratropium

Q 89: Cystic lung disease in women of childbearing age

Ans: Lymphangioleiomyomatosis

Q 90: Late, severe complication of silo filler's disease

Ans: Brochiolitis obliterans

Q 91: Number of persons with a disease compared to entire population

Ans: Prevalence

Q 92: Number of persons who develop disease per unit time compared to entire
population
Ans: Incidence

Q 93: Probability of a positive test in a patient with disease compared to the probability
in a patient without disease
Ans: Positive likelihood ratio (or likelihood ratio)

Q 94: Direction of change of the positive predictive value when disease prevalence
increases
Ans: Increase

Q 95: Calculated as 1/(absolute rate reduction)

Ans: NNT or number needed to treat

Q 96: Most important factor determining prognosis following myocardial infarction

Ans: Left ventricular ejection fraction

Q 97: Coronary artery most often responsible for ischemic papillary muscle rupture
Ans: Posterior descending artery (accept RCA)

Q 98: Diagnosis associated with bradycardia and variable intensity of S1

Ans: Complete heart block (or 3rd degree heart block)

Q 99: Presence of this drug is a contraindication to calcium gluconate in the treatment

of hyperkalemia
Ans: Digitalis

Q 100: Drugs used for "pill-in-the-pocket" treatment of atrial fibrillation

Ans: Flecainide and propafenone

Q 101: Chest x-ray finding

Ans: Lung nodule

Q 102: Sleep disorder that can be associated with difficult to treat systemic
hypertension
Ans: Obstructive sleep apnea

Q 103: Diagnosis suggested by persistently split S2, loud pulmonary closure, and
prominent right ventricular impulse
Ans: Pulmonary hypertension

Q 104: Eponym associated with radiographic diagnosis

Ans: Pancoast tumor

Q 105: Diagnoses suggested by this x-ray

Ans: Chronic eosinophilic pneumonia

Q 106: Name describing generalized swelling of an entire digit

Ans: Dactylitis

Q 107: Eponym for a bruise over the mastoid, indicating a basal skull fracture
Ans: Battle's sign

Q 108: Eponym associated with water-hammer type pulse

Ans: Corrigan's pulse

Q 109: Eponym associated with systolic plethora and diastolic blanching in the nail
Ans: Quincke's pulse
Q 110: Eponym for this finding

Ans: Pemberton's sign

Q 111: Location of surgeries associated with greatest risk in patients with COPD
Ans: Upper abdominal or thoracic (accept either)

Q 112: Duration of prophylactic antibiotics for uncomplicated surgical procedures

Ans: 24 hours

Q 113: Recommended preoperative screening prior to cataract surgery

Ans: None

Q 114: Percentage of patients with a negative history but abnormal bleeding tests that
require preoperative treatment
Ans: 0.3% (less than 1% acceptable)

Q 115: General surgery may be safely performed if the INR is below this level
Ans: 1.5

Q 116: Chronic renal failure increases risk for this third trimester pregnancy
complication
Ans: Preeclampsia

Q 117: Most common causes of postpartum thyrotoxicosis

Ans: Graves disease or postpartum thyroiditis (either)

Q 118: Vasodilator of choice for peripartum cardiomyopathy

Ans: Hydralazine

Q 119: Treatment of gestational hypertension improves this renal outcome

Ans: Decreased proteinuria

Q 120: Pregnancy complication of untreated Trichomonas vaginitis

Ans. Premature rupture of membranes or preterm delivery(either)

Q121: Only known vector for West Nile virus

Ans: Mosquitoes

Q 122: Animal associated with greatest number of rabies cases in the United States
Ans: Bats

Q 123: Recommended treatment for first relapse of C. difficile diarrhea

Ans: Second course of metronidazole

Q 124: Gram-stain finding in expectorated sputum from a chemotherapy patient

Ans: Candida

Q 125: An oral prodrug of ganciclovir for treatment of CMV retinitis

Ans: Valganciclovir

Q 126: Best initial imaging test for subarachnoid hemorrhage

Ans: Noncontrast CT

Q 127: Finding on echocardiogram in patient with a stroke

Ans: Clot in left atrium

Q 128: Transient, acute memory loss lasting for minutes without loss of consciousness
Ans: Transient global amnesia

Q 129: Periodic headache classically found in male smokers

Ans: Cluster headache

Q130: Auditory symptom associated with Bell's palsy

Ans: Hyperacusis

Q 131: Common fruit drink that inhibits cyctochrome P-450 isoenzyme CYP3A4
Ans: Grapefruit juice

Q 132: Drug that is involved in the greatest number of serious drug-drug interactions
Ans: Warfarin

Q 133: Mechanism of action of most nerve gas agents

Ans: Inhibit cholinesterase

Q 134: Common divalent cation that interferes with absorption of fluroquinolones

Ans: Calcium or magnesium

Q 135: Drug used to treat bleeding associated with hereditary hemorrhagic

telangiectasia
Ans: Combination estrogen/progesterone (accept hormone therapy)
Q 136: Blood pressure goal for heart failure, previous MI, or chronic kidney disease
Ans: < 130/80

Q 137: Diagnosis associated with equalization of diastolic pressures in right atrium, right
ventricle, wedge pressure, and left ventricle
Ans: Tamponade or constrictive pericarditis

Q 138: ECG diagnosis of conduction disturbance

Ans: Mobitz type 1 (Wenckebach)

Q 139: Most common congenital cause of chronic aortic regurgitation

Ans: Bicuspid aortic valve

Q 140: Drug reduces risk for aortic valve replacement for chronic aortic regurgitation
Ans: Nifedipine

Q 141: Agent responsible for cervical cancer

Ans: Human papillomavirus

Q 142: Age to discontinue Pap smears in low-risk women

Ans: Age 65 years

Q 143: Drug for bacterial vaginosis

Ans: Metronidazole

Q 144: Window of time for effective "emergency contraception"

Ans: 72 hours
Q 145: Topical drug for vulvar lichen simplex chronicus
Ans: Topical fluorinated corticosteroids (accept topical steroids)

Q 146: Nobel awardee for discovery of tubercle bacillus

Ans: Robert Koch

Q 147: Nobel awardee for discovery of insulin

Ans: Sir Frederick Banting or J.J.R. Macleod

Q 148: Oldest medical school in the U.S.

Ans: University of Pennsylvania

Q 149: First to see red blood cells with a microscope

Ans: Anthony Van Leeuwenhoek

Q 150: Civil war surgeon who made over 10,000 contributions to the Oxford English
Dictionary while an inmate at insane asylum
Ans: William Chester Minor

Q 151: Blood test to distinguish primary from secondary adrenal insufficiency

Ans: ACTH

Q 152: Radiographic diagnosis of bone disease

Ans: Paget's disease (osteitis deformans)

Q 153: Production is increased in sarcoidosis and contributes to hypercalcemia

Ans: 1,25-dihydroxycholecaciferol
Q 154: Diabetic syndrome of symmetric proximal leg weakness and pain
Ans: Diabetic amyotrophy

Q 155: Preferred imaging test for insulinoma

Ans: Endoscopic ultrasonography

Q 156: Highly contagious viral cause of conjunctivitis

Ans: Adenoviruses or picornaviruses (either answer)

Q 157: Ocular finding in hypercalcemia

Ans: Band keratopathy

Q 158: Pupil with consensual but not direct response to light

Ans: Marcus Gunn pupil (afferent pupillary defect)

Q 159: Adhesions that develop between the iris and lens capsule following iritis
Ans: Synechiae

Q 160: Diagnostic procedure of choice for a patient with endophthalmitis

Ans: Aspiration and culture of anterior chamber (accept either part of answer)

Q 161: Two most frequent symptoms of mild carbon monoxide poisoning

Ans: Headache and nausea

Q 162: Accumulation of this gas is responsible for decompression illness

Ans: Nitrogen

Q 163: Alcohol poisoning associated with acetone breath and normal acid-base status
Ans: Isopropyl alcohol

Q 164: Medical significance of N-acetyl-p-benzoquinoneimine (NAPQI)

Ans: Toxic metabolite of acetominophen

Q 165: Intravenous treatment for cyanide poisoning

Ans: Sodium thiosulfate

Q 166: Most states require this consent prior to immunization of an adolescent

Ans: Parental consent

Q 167: Unethical activity with a patient even if patient initiates or consents to the
activity
Ans: Sexual contact
Q 168: Principle confirms the right of patients to make own health care decisions, even
if unwise
Ans: Autonomy

Q 169: Federal Act of 1996 contains rules about privacy of medical records
Ans: Health Insurance Portability and Accountability Act (HIPAA)

Q 170: An advance directive appointing a surrogate who will make decisions if the
patient is unable to do so
Ans: Durable power of attorney (for health care)

Q 171: Treatment for "porcelain gallbladder"

Ans: Cholecystectomy

Q 172: Best test for suspected sclerosing cholangitis

Ans: ERCP (accept MRCP)

Q 173: Gastrointestinal polyps and pigmented macules around mouth and lips
Ans: Peutz-Jeghers' disease

Q 174: Diagnosis associated with diarrhea, metabolic acidosis and potassium loss
Ans: Villous adenoma or laxative abuse (either)

Q 175: Drug for irritable bowel syndrome associated with ischemic colitis
Ans: Alosetron

Q 176: Peripheral blood smear diagnosis

Ans: Sickle cell disease

Q 177: Best drug for warm-antibody autoimmune hemolytic anemia

Ans: Corticosteroids

Q 178: Common infectious cause of transient reticulocytopenia

Ans: Parvovirus B19

Q 179: Eponym for hemolytic anemia and immune thrombocytopenic purpura

Ans: Evans syndrome

Q 180: Hydroxyurea re-activates expression of this developmentally silenced protein

Ans: Fetal gamma globulin