CMS II Cumulative Exam- KEY WORDS & IDEAS

c. Cauda equina syndrome

(bowel & bladder incontinence, LE weakness, gait disturbance)

Saddle anesthesia

a. Trigeminal neuralgia

b. Botulism

c. Cauda equina syndrome

d. Guillain barre syndrome (GBS)

b. Tension HA

B/L "BAND LIKE," non-throbbing, HA that is NOT worsened with exertion

a. Migraine HA

b. Tension HA

c. Cluster HA

d. Subarachnoid hemorrhage

a. Migraine HA

Lateralized, pulsatile (throbbing) headache, with N/V & photophobia, +/- aura

a. Migraine HA

b. Tension HA

c. Cluster HA

d. Subarachnoid hemorrhage

a. Meningitis

Nuchal rigidity & + Brudzinski/Kernig, HA worsens when sitting upright

a. Meningitis

b. Encephalitis

c. Subclavial steal syndrome

d. Parkinson's disease

a. Dementia

Chronic impairment of consciousness

a. Dementia

b. Delirium

c. Parkinson's disease

d. Old age

b. Delirium

Abrupt confused state with an identifiable cause

a. Concussion

b. Delirium

c. Dementia

d. Psychosis

a. Median

Nerve entrapped in carpal tunnel syndrome

a. Median

b. Radial

c. Ulnar

d. Musculocutaneous

c. Botulism

(babies eating honey)

Symmetrical descending weakness

a. Guillain barre syndrome (GBS)

b. Cauda equina syndrome

c. Botulism

d. Peripheral neuropathy

a. Guillain barre syndrome (GBS)

(C. jejuni is a precipitating factor)

Symmetrical ascending weakness

a. Guillain barre syndrome (GBS)

b. Cauda equina syndrome

c. Botulism

d. Peripheral neuropathy

b. Trigeminal neuralgia

(Tx --> Carbamazepine)

Brief lancinating pain that hurts even when a feather brushes the face

a. Guillain barre syndrome

b. Trigeminal neuralgia

c. Bell's palsy

d. Transient ischemic attack (TIA)

b. Subarachnoid hemorrhage

"Worst HA of my life" caused by a ruptured berry aneurysm

a. Intraparenchymal hemorrhage

b. Subarachnoid hemorrhage

c. Epidural hemorrhage

d. Subdural hemorrhage

d. Trichomoniasis

Strawberry cervix, pear-shaped organisms with minimal tail, frothy vaginal discharge

a. Chlamydia

b. Candidiasis

c. Bacterial vaginosis

d. Trichomoniasis

c. Bacterial vaginosis

(MCC of vaginitis in women of childbearing age)

Fishy smell, clue cells

a. Chlamydia

b. Candidiasis

c. Bacterial vaginosis

d. Trichomoniasis

b. Candidiasis

Yeast buds, pseudohyphae, cottage cheese discharge

a. Chlamydia

b. Candidiasis

c. Bacterial vaginosis

d. Trichomoniasis

c. Legg-calve perthes disease

Avascular necrosis of femoral head

a. Septic arthritis

b. Slipped capital femoral epiphysis (SCFE)

c. Legg-calve perthes disease

d. Osteomyelitis

b. Slipped capital femoral epiphysis (SCFE)

(seen in adolescent obese males; DISPLACEMENT of femoral head)

Ice cream falling off cone on x-ray, Kline's line, screw placement (tx)

a. Septic arthritis

b. Slipped capital femoral epiphysis (SCFE)

c. Legg-calve perthes disease

d. Osteomyelitis

b. MCL

+ VaLgus test, what's injured?

a. ACL

b. MCL

c. LCL

d. PCL

c. LCL

+ VaRus test, what's injured?

a. ACL

b. MCL

c. LCL

d. PCL

a. Osteosarcoma

(originates from metaphysis)

Hair on end or sunburst appearance on x-ray

a. Osteosarcoma

b. Osteochondroma

c. Ewing's sarcoma

d. Multiple myeloma

c. Gout

(MC site = 1st MTP joint (podagra))

Tophi, uric acid crystals

a. Osteoarthritis

b. Rheumatoid arthritis

c. Gout

d. Pseudogout

d. Rheumatoid arthritis

Morning stiffness >1 hr, improves throughout the day, DIP joints are SPARED, symmetric, swan neck & boutonniere deformities

a. Psoriatic arthritis

b. Osteoarthritis

c. Reactive arthritis

d. Rheumatoid arthritis

c. Reactive arthritis

(conjunctivitis, urethritis, arthritis)

Can't see, can't pee, can't climb a tree

a. Psoriatic arthritis

b. Osteoarthritis

c. Reactive arthritis

d. Rheumatoid arthritis

b. Osteoarthritis

Pain worsens throughout the day, osteophytes, asymmetric, CMC squaring of the hands

a. Psoriatic arthritis

b. Osteoarthritis

c. Reactive arthritis

d. Rheumatoid arthritis

d. Pseudogout

Positively birefringent rhomboid-shaped crystals, chondrocalcinosis on x-ray

a. Osteoarthritis

b. Rheumatoid arthritis

c. Gout

d. Pseudogout

c. Osgood schlatter

Adolescent athlete with pain & swelling over tibial tuberosity

a. ACL tear

b. Chondromalacia patella

c. Osgood schlatter

d. Tendonitis

d. Subclavian steal syndrome

BP different b/t arms by >15 mmHg

a. TIA

b. Trigeminal neuralgia

c. Peripheral neuropathy

d. Subclavian steal syndrome

a. Bell's palsy

Hemifacial weakness & paralysis that may be due to HSV reactivation

a. Bell's palsy

b. Encephalitis

c. Shingles

d. Ramsay hunt syndrome

d. Spondylosis

Scottie dog sign

a. Spondylitis

b. Scoliosis

c. Spondylolisthesis

d. Spondylosis

d. Ortolani

(examiner aBducts the hip while applying an anterior force on the femur to reduce the hip joint)

Maneuver for hip dysplasia used to REDUCE the joint

a. Monteggia

b. Galeazzi

c. Barlow

d. Ortolani

c. Barlow

(examiner aDducts the hip while applying a posterior force on the knee to promote dislocation)

Maneuver for hip dysplasia used to promote DISLOCATION

a. Monteggia

b. Galeazzi

c. Barlow

d. Ortolani

d. B/t 3rd & 4th metatarsals

(lacinating or burning pain esp with weight bearing)

Where is Morton's neuroma most commonly found?

a. B/t 1st & 2nd metacarpals

b. B/t 3rd & 4th metacarpals

c. B/t 1st & 2nd metatarsals

d. B/t 3rd & 4th metatarsals

b. Acute mesenteric ischemia

Severe abdominal pain out of proportion to PE findings

a. Ulcerative colitis

b. Acute mesenteric ischemia

c. Diverticulitis

d. Zenker's diverticulum

c. Norovirus

MCC of gastroenteritis in adults in north amercica, found on cruise ships/hospitals/restaurants

a. Legionella

b. E. coli

c. Norovirus

d. Rotavirus

a. Zenker's diverticulum

Weakness at Killian's triangle leading to halitosis & dysphagia

a. Zenker's diverticulum

b. Wilson's disease

c. Boerhaave's syndrome

d. Mallory weiss tear

d. Diffuse esophageal spasm

(sometimes treated as chest pain & Nitro aids with relief)

"Corkscrew" on barium studies

a. Acute mesenteric ischemia

b. Diverticulitis

c. Achalasia

d. Diffuse esophageal spasm

c. Achalasia

"Bird's beak" tapering of esophagus

a. Acute mesenteric ischemia

b. Diverticulitis

c. Achalasia

d. Diffuse esophageal spasm

b. Wilson's disease

Kayser-Fleischer rings

a. Zenker's diverticulum

b. Wilson's disease

c. Boerhaave's syndrome

d. Mallory weiss tear

b. IBS

Abdominal pain that IMPROVES with defecation

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

a. Stool volume decreases with fasting

In osmotic diarrhea..

a. Stool volume decreases with fasting

b. Stool volume increases with fasting

c. Little change in stool with fasting

d. Stool becomes ribbon-like with fasting

c. Little change in stool with fasting

In secretory diarrhea..

a. Stool volume decreases with fasting

b. Stool volume increases with fasting

c. Little change in stool with fasting

d. Stool becomes ribbon-like with fasting

d. Boerhaave's syndrome

Full thickness esophageal tear from forceful retching/vomiting

a. Mallory weiss tear

b. Zenker's diverticulum

c. Diverticulosis

d. Boerhaave's syndrome

a. Mallory weiss tear

Superficial mucosal aspiration + UGI, vomiting blood (hematemesis), hx of excessive alcohol intake

a. Mallory weiss tear

b. Zenker's diverticulum

c. Diverticulosis

d. Boerhaave's syndrome

c. Crohn's disease

(can be in ANY GI segment from mouth to anus; typically rectal sparing)

Skip lesions, cobblestoning (usually rectal sparing)

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

a. Ulcerative colitis

(limited to colon)

Crypt abscesses/crypts of Lieberkuhn & rectal involvement

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

a. Primary syphilis

(syphilis caused by treponema pallidum; syphiLESS = painless)

Painless ulcer with “punched out appearance & rolled edges” aka chancre

a. Primary syphilis

b. Secondary syphilis

c. Tertiary (latent) syphilis

d. Congenital syphilis

b. Secondary syphilis

"Money spots" on palms & soles

a. Primary syphilis

b. Secondary syphilis

c. Tertiary (latent) syphilis

d. Congenital syphilis

d. 16 & 18

(6 & 11 = anogenital warts)

Strains of HPV responsible for cervical & anal cancers

a. 3 & 8

b. 6 & 11

c. 12 & 15

d. 16 & 18

a. Follicular

(proliFerative = Follicular; ovulation & luteal are also phases of ovarian cycle, secretory is not)

Proliferative phase of uterine cycle corresponds to this phase of ovarian cycle

a. Follicular

b. Ovulation

c. Luteal

d. Secretory

c. Luteal

Secretory phase of uterine cycle roughly corresponds to this phase of ovarian cycle

a. Follicular

b. Ovulation

c. Luteal

d. Proliferative

b. Stress incontinence

(1st line non-pharm tx: kegels)

Loss of urine due to coughing, sneezing, laughing, exercising

a. Overflow incontinence

b. Stress incontinence

c. Urge incontinence

d. Mixed incontinence

a. Overflow incontinence

(urinary retention leads to bladder distention)

Uncontrollable dribbling of urine

a. Overflow incontinence

b. Stress incontinence

c. Urge incontinence

d. Mixed incontinence

c. Urge incontinence

Uninhibited detrusor muscle contractions

a. Overflow incontinence

b. Stress incontinence

c. Urge incontinence

d. Mixed incontinence

b. Mixed incontinence

Stress + urge incontinence =

a. Total incontinence

b. Mixed incontinence

c. Post-void residual

d. Overflow incontinence

a. February 13, 2023

(- 3 months, + 7 days, + 1 year)

Calculate Naegele's Rule:

LMP: May 6, 2022

a. February 13, 2023

b. February 6, 2023

c. March 13, 2023

d. March 6, 2023

a. Preeclampsia

(CURATIVE tx = delivery)

Pregnant with new onset HTN + proteinuria + edema

a. Preeclampsia

b. Eclampsia

c. Chronic HTN

d. HELLP syndrome

c. Eclampsia

Preeclampsia + seizures =

a. HELLP syndrome

b. Premature rupture of membranes (PROM)

c. Eclampsia

d. Placental abruption

c. Placenta previa

(tocolytics... eventually c-section!!)

Painless bleeding during 3rd trimester

a. Artificial rupture of membranes (AROM)

b. Spontaneous rupture of membranes (SROM)

c. Placenta previa

d. Placental abruption

d. Placental abruption

Vaginal bleeding + back pain

a. Artificial rupture of membranes (AROM)

b. Spontaneous rupture of membranes (SROM)

c. Placenta previa

d. Placental abruption

c. Ectopic pregnancy

(tx --> Methotrexate; ↑ HCG, but can't find anything in the uterus)

Pregnant + abdominal pain --> must rule this out

a. Inevitable abortion

b. Missed abortion

c. Ectopic pregnancy

d. Placenta previa

d. Ampullary

(all of these are included in tubal ectopics)

MC location for ectopic pregnancy

a. Interstitial

b. Isthmic

c. Fimbrial

d. Ampullary

b. Premature rupture of membranes (PROM)

Pooling of fluid, Nitrazine (test/dye to evaluate pH), ferning (leafy pattern on a slide)

a. HELLP syndrome

b. Premature rupture of membranes (PROM)

c. Artificial rupture of membranes (AROM)

d. Spontaneous rupture of membranes (SROM)

c. Colles fracture

Fall onto outstretched hand (FOOSH), dinner fork deformity

a. Tennis elbow

b. Golfer's elbow

c. Colles fracture

d. Smith's fracture

c. Ehlers-danlos syndrome

Joint hypermobility & hyperextensible skin

a. Polymyositis

b. Sjogren's syndrome

c. Ehlers-danlos syndrome

d. Crest syndrome

d. Dermatomyositis

Heliotrope rash, mechanic's hands, shawl rash, gottron's sign

a. Osteoarthritis

b. Rheumatoid arthritis

c. Polymyositis

d. Dermatomyositis

b. Sjogren's syndrome

Xerostomia (dry mouth), keratoconjunctivitis sicca (dry eyes), parotid gland enlargement

a. Polymyositis

b. Sjogren's syndrome

c. Ehlers-danlos syndrome

d. Crest syndrome

c. De Quervain tenosynovitis

Ulnar deviation causes pain, + Finkelstein test

a. Dupuytren Contracture

b. Infectious tenosynovitis

c. De Quervain tenosynovitis

d. Carpal tunnel syndrome

b. Parkinson's disease

Shuffling gait, flat affect, relieved with voluntary activity, intentional movement, & sleep (worst at rest)

a. Dementia

b. Parkinson's disease

c. Peripheral neuropathy

d. Delirium

c. Cushing syndrome

(MCC = exogenous glucocorticoids; assoc with the anterior pituitary)

Purple striae, buffalo hump, oily skin, moon face

a. Pretibial Myxedema

b. Pheochromocytoma

c. Cushing syndrome

d. Addison's disease

b. Pheochromocytoma

Get up & BP “skyrockets;” multiple cafe au lait spots

a. Pretibial Myxedema

b. Pheochromocytoma

c. Cushing syndrome

d. Addison's disease

a. Psoriatic arthritis

"Pencil in cup" deformity, sausage digits

a. Psoriatic arthritis

b. Osteoarthritis

c. Reactive arthritis

d. Rheumatoid arthritis

c. Vascular dementia

Lacunar infarcts (aka small subcortical lucencies on MRI)

a. Lewy bodies dementia

b. Cerebral malaria

c. Vascular dementia

d. Alzheimer's disease

a. Lewy bodies dementia

Hallucinations & delusions

a. Lewy bodies dementia

b. Cerebral malaria

c. Vascular dementia

d. Alzheimer's disease

b. Depression

(give PHQ-9)

Think they have dementia, but aware of deficits & often complain of memory loss

a. Anxiety

b. Depression

c. Delirium

d. True dementia

a. Presbycusis

MCC sensorineural hearing loss

a. Presbycusis

b. Meniere's disease

c. Cerumen impaction

d. Otitis media

d. Cerumen impaction

MCC conductive hearing loss

a. Presbycusis

b. Medications

c. Head injury

d. Cerumen impaction

b. PUD

(UPper = PUd)

MCC upper GI bleed

a. Crohn’s disease

b. PUD

c. Cholecystitis

d. Diverticulosis

a. Diverticulosis

(diverticuLOWsis)

MCC lower GI bleed

a. Diverticulosis

b. PUD

c. Ulcerative colitis

d. Pancreatitis

c. Upper GI bleed

"Coffee ground" aspirate

a. Primary Biliary Cirrhosis

b. Primary Sclerosing Cholangitis

c. Upper GI bleed

d. Lower GI bleed

d. Normal pressure hydrocephalus

Progressive dementia + urinary incontinence + apraxic gait =

a. Parkinson's disease

b. Frontotemporal dementia (Pick's disease)

c. Lewy body dementia

d. Normal pressure hydrocephalus

a. Alzheimer's disease

MC type of dementia, tangles, cortical atrophy, amyloid plaques

a. Alzheimer's disease

b. Lewy body dementia

c. Vascular dementia

d. Frontotemporal dementia (Pick's disease)

d. Frontotemporal dementia (Pick's disease)

Onset < 60 y/o + behavioral changes

a. Alzheimer's disease

b. Lewy body dementia

c. Vascular dementia

d. Frontotemporal dementia (Pick's disease)

c. Absence seizure

Child that appears to be "dreaming," no LOC or loss of body tone

a. Infantile spasm

b. Myoclonic seizure

c. Absence seizure

d. Generalized tonic-clonic seizure

d. Generalized tonic-clonic seizure

Sudden LOC, becomes stiff before jerking. Postictal phase occurs, +/- cyanosis & urinary incontinence

a. Infantile spasm

b. Myoclonic seizure

c. Absence seizure

d. Generalized tonic-clonic seizure

a. Lyme disease

Erythematous wheal with central clearing aka "bull's eye" lesion

a. Lyme disease

b. Dermatomyositis

c. Allergic dermatitis

d. Acute cutaneous lupus erythematosus (ACLE)

d. Paget's disease

"Salt & pepper" pattern on x-ray + enlarged skull, tinnitus, bowed legs

a. Ascending spinal fusion

b. Avascular Necrosis

c. Classic PAN

d. Paget's disease

a. HypERthyroidism

Low TSH + High FT4/FT3

a. HypERthyroidism

b. HypOthyroidism

c. Hyperparathyroidism

d. Hypoparathyroidism

b. HypOthyroidism

High TSH + Low FT4/FT3

a. HypERthyroidism

b. HypOthyroidism

c. Hyperparathyroidism

d. Hypoparathyroidism

b. Sheehan's syndrome

Postpartum & goes into adrenal crisis (not lactating)

a. Addison's disease

b. Sheehan's syndrome

c. Grave's disease

d. Pheochromocytoma

d. Acanthosis Nigricans

Hyperpigmentation & skin thickening to the flexural areas

a. Pretibial Myxedema

b. Dermatomyositis

c. Classic PAN

d. Acanthosis Nigricans

b. Drug-induced lupus

Anti-Histone antibodies

a. Neonatal lupus

b. Drug-induced lupus

c. Acute cutaneous lupus

d. Chronic cutaneous lupus

d. Rhabdomyolysis

(acute muscle injury syndrome; myoglobin = the pigment in the urine, not blood)

Muscle pain + muscle weakness/swelling + dark tea-colored urine

a. Rheumatoid arthritis

b. Sarcoidosis

c. Paget's disease

d. Rhabdomyolysis

c. Encephalitis

HA + stiff neck + fever + altered mental status

a. Meningitis

b. Parkinsons

c. Encephalitis

d. Delirium

b. Cluster HA

U/L HA, non-throbbing periorbital pain that's worse at night, ipsilateral lacrimation & rhinorrhea

a. Tension HA

b. Cluster HA

c. Migraine HA

d. Post-traumatic HA

a. Scoliosis

"Rib hump"

a. Scoliosis

b. Kyphosis

c. Lordosis

d. Scheuermann's disease

c. Nursemaid's elbow

"Pulling away" activity, swinging child that results in child refusing to use arm

a. Fracture of olecranon process of ulna

b. Fracture of distal humerus

c. Nursemaid's elbow

d. Hemarthrosis

a. Duodenal ulcer

Epigastric pain relieved with food (aka worsened with fasting)

a. Duodenal ulcer

b. Gastric ulcer

c. Achalasia

d. GERD

b. Gastric ulcer

(gaStric = worSened with Snacks)

Epigastric pain worsened with food (aka relieved with fasting)

a. Duodenal ulcer

b. Gastric ulcer

c. Achalasia

d. GERD

d. Celiac disease

Dermatitis herpetiformis, loss of muscle or subq fat

a. Dumping syndrome

b. Lactase deficiency

c. IBS

d. Celiac disease

a. Dumping syndrome

(dumping of stomach contents into proximal small intestine --> fluid shifts from blood to SI to dilute contents, hypOvolemia occurs, food is rapidly digested & absorbed which causes hypERglycemia & inc insulin secretion, but eventually hypOglycemia develops 2-3 hrs later)

Malabsorption s/p gastric surgery (i.e. gastrectomy for PUD or gastric bypass)

a. Dumping syndrome

b. Lactase deficiency

c. IBS

d. Celiac disease

d. Acute paralytic ileus

HypERactive, high pitched "tinkling" bowel sounds, peristaltic "rushes"

a. Volvulus

b. Intussusception

c.Hirschsprung disease

d. Acute paralytic ileus