CMS III Cumulative Exam- KEY WORDS & IDEAS

a. Acute tubular necrosis

Muddy brown casts + FENa (%) is >1

a. Acute tubular necrosis

b. Acute pyelonephritis

c. Chronic Renal Failure

d. Membranous nephropathy

b. Acute pyelonephritis

White cell casts

a. Acute tubular necrosis

b. Acute pyelonephritis

c. Chronic Renal Failure

d. Membranous nephropathy

c. Wilm's tumor

"Abdominal mass in African American child," horseshoe kidney & hypospadias

a. Minimal change disease

b. Polycystic kidney disease

c. Wilm's tumor

d. Mesoblastic nephroma

d. Long thoracic

Winged scapula is caused by cutting of which nerve?

a. Musculocutaneous

b. Suprascapular

c. Lateral anterior thoracic

d. Long thoracic

b. Adhesions

(from previous surgery)

MCC SBO in Western nations

a. Malignancies

b. Adhesions

c. Medications

d. Hernias

d. Hernias

MCC SBO worldwide

a. Malignancies

b. Adhesions

c. Medications

d. Hernias

b. Erb's palsy

"Waiter's tip"

a. Klumpke palsy

b. Erb's palsy

c. Bell's palsy

d. Cerebral palsy

a. Klumpke palsy

"Claw hand"

a. Klumpke palsy

b. Erb's palsy

c. Bell's palsy

d. Cerebral palsy

a. Coarctation of aorta (coA)

Rib notching or "figure of 3 sign" on x-ray

a. Coarctation of aorta (coA)

b. Tricuspid atresia

c. Hypoplastic left heart (HLH)

d. Tetralogy of fallot (ToF)

b. Small bowel obstruction

"String of pearls" or "stack of coins"

a. Appendicitis

b. Small bowel obstruction

c. Diverticulitis

d. Acute cholecystitis

d. Tetralogy of fallot (ToF)

"Boot-shaped" on x-ray

a. Coarctation of aorta (coA)

b. Tricuspid atresia

c. Hypoplastic left heart (HLH)

d. Tetralogy of fallot (ToF)

c. AML

(Trisomy 21 at higher risk)

Auer rods

a. TTP

b. ITP

c. AML

d. ALL

b. ITP

Megathromboytes (Giant platelets)

a. TTP

b. ITP

c. AML

d. ALL

a. TTP

Schistocytes on peripheral blood smear

a. TTP

b. ITP

c. AML

d. ALL

d. HHV-6

Associated with febrile seizures

a. RSV

b. CMV

c. HPV

d. HHV-6

b. E. coli

MCC UTI in kids

a. S. aureus

b. E. coli

c. Staphylococcus

d. Enterococcus

c. Rubeola

Koplik spots

a. Rubella

b. Roseola

c. Rubeola

d. Varicella

a. Rubella

(aka german measles)

Forchheimer spots

a. Rubella

b. Roseola

c. Rubeola

d. Varicella

b. Roseola

Rash STARTS on neck & trunk

a. Rubella

b. Roseola

c. Rubeola

d. Varicella

d. Varicella

(chicken pox)

"Dewdrop on a rose petal" lesions

a. Rubella

b. Roseola

c. Rubeola

d. Varicella

b. Ketamine

Causes post-op disorientation

a. Propofol

b. Ketamine

c. Succinylcholine

d. Fentanyl

d. Spermatocele

Non tender mass on posterior part of testicle

a. Enterocoele

b. Cystocele

c. Rectocele

d. Spermatocele

c. Epispadias

Urethral meatus located on the DORSAL aspect of the penis

a. Varicocele

b. Hydrocele

c. Epispadias

d. Hypospadias

d. Hypospadias

Urethral meatus is located on the VENTRAL aspect of the penis

a. Varicocele

b. Hydrocele

c. Epispadias

d. Hypospadias

b. Varicocele

"Bag of worms"

a. Spermatocele

b. Varicocele

c. Hydrocele

d. Rectocele

c. Smoking

Biggest risk factor for bladder cancer

a. Obesity

b. Hx testicular cancer

c. Smoking

d. BPH

b. Blastomycosis

Large, ovoid yeasts

a. Cryptococcosis

b. Blastomycosis

c. Histoplasmosis

d. Onchocerca volvulus

a. Cryptococcosis

Encapsulated yeast

a. Cryptococcosis

b. Blastomycosis

c. Histoplasmosis

d. Onchocerca volvulus

c. Histoplasmosis

"Fish eye" yeasts

a. Cryptococcosis

b. Blastomycosis

c. Histoplasmosis

d. Onchocerca volvulus

d. Onchocerca volvulus

"River blindness"

a. Cryptococcosis

b. Blastomycosis

c. Histoplasmosis

d. Onchocerca volvulus

a. Infantile diarrhea

Enteropathogenic E. coli

a. Infantile diarrhea

b. HUS

c. Disease similar to shigellosis

d. Traveler's diarrhea

d. Traveler's diarrhea

Enterotoxigenic E. coli

a. Infantile diarrhea

b. HUS

c. Disease similar to shigellosis

d. Traveler's diarrhea

b. HUS

Enterohemorrhagic E. coli

a. Infantile diarrhea

b. HUS

c. Disease similar to shigellosis

d. Traveler's diarrhea

c. Disease similar to shigellosis

Enteroinvasive E. coli

a. Infantile diarrhea

b. HUS

c. Disease similar to shigellosis

d. Traveler's diarrhea

b. PJP pneumonia

(tx --> Bactrim)

MC opportunistic infection with AIDS

a. Tuberculosis

b. PJP pneumonia

c. Glomerulonephritis

d. Hemolytic uremic syndrome (HUS)

a. Nephritic syndrome

Cola-colored urine, red cell casts

a. Nephritic syndrome

b. Nephrotic syndrome

c. Goodpasture's syndrome

d. Diabetic nephropathy

b. Nephrotic syndrome

Peripheral edema is a hallmark

a. Nephritic syndrome

b. Nephrotic syndrome

c. Goodpasture's syndrome

d. Diabetic nephropathy

b. Lead poisoning

Basophilic stippling on blood smear

a. Iron deficiency anemia

b. Lead poisoning

c. Vit B12 deficiency

d. Folate deficiency

a. Hodgkin's lymphoma

Reed Sternberg cells

a. Hodgkin's lymphoma

b. Non-hodgkin's lymphoma

c. ALL

d. AML

c. Mono

(AVOID CONTACT SPORTS)

Fever + sore throat + (posterior) cervical lymphadenopathy + SPLENOMEGALY =

a. Strep throat

b. Pneumonia

c. Mono

d. URI

b. Pseudomonas

"Hot tub folliculitis"

a. LGV

b. Pseudomonas

c. HSV

d. Strep pneumo

b. Klebsiella pneumoniae

Homeless alcoholic with currant jelly sputum (blood-stained)

a. Legionella pneumophila

b. Klebsiella pneumoniae

c. Mycoplasma pneumoniae

d. CAP

d. Chlamydia psittaci

Worked at a pet store, kisses parrots 🦜❤️

a. Legionella pneumophila

b. Chlamydia pneumoniae

c. Mycoplasma pneumoniae

d. Chlamydia psittaci

c. Staph scalded skin syndrome

(Nikolsky's sign = slight rubbing of the skin results in exfoliation of the outermost layer)

Nikolsky's sign

a. Toxic shock syndrome

b. Necrotizing fasciitis

c. Staph scalded skin syndrome

d. Cellulitis

a. Microcephaly

Complication assoc with Zika

a. Microcephaly

b. Macrocephaly

c. Coarctation of aorta (coA)

d. Cerebral edema

c. Digoxin OD

Yellow vision & 1st higher degree heart block

a. Anticholinergic OD

b. Opioid OD

c. Digoxin OD

d. Acetaminophen OD

c. Iron toxicity

Hemorrhagic diarrhea

a. CCB toxicity

b. TCA toxicity

c. Iron toxicity

d. Lead poisoning

a. Liver

Most common organ affected by penetrating abd injury

a. Liver

b. Spleen

c. Pancreas

d. Small intestine

b. Spleen

Most common organ affected by blunt abd injury

a. Liver

b. Spleen

c. Pancreas

d. Small intestine

a. Seabather's itch

Went in ocean & gets rash in regions that bathing suit covered

a. Seabather's itch

b. Stingray

c. Portuguese man-of-war

d. Ciguatera fish poisoning

a. Stingray

MC fish envenomation

a. Stingray

b. Shark

c. Ciguatera

d. Portuguese man-of-war

b. Pyloric stenosis

(U/S confirms this dx)

Projectile vomiting + olive shaped mass

a. Cyclic vomiting syndrome

b. Pyloric stenosis

c. Hirschsprung disease

d. Wilson's disease

c. Acute renal failure

Oliguria is a hallmark for

a. Acute pyelonephritis

b. Chronic pyelonephritis

c. Acute renal failure

d. Chronic renal failure

b. Minimal change disease

MCC nephrotic syndrome in kids

a. Glomerulonephritis

b. Minimal change disease

c. Acute pyelonephritis

d. Acute Tubular Necrosis

d. Scarlet fever

Sandpaper rash, strawberry tongue, hx of strep throat

a. Lyme disease

b. Kallman syndrome

c. Kawasaki syndrome

d. Scarlet fever

b. Rickettsia rickettsii

(tx --> Doxy)

Assoc with Rocky Mountain Spotted Fever

a. S. aureus

b. Rickettsia rickettsii

c. Toxoplasmosis gondii

d. P. aeruginosa

c. Basilar

Migraine assoc with vertigo

a. Migraine with aura

b. Migraine without aura

c. Basilar

d. Tension

c. Sturge weber syndrome

Facial nevus (port-wine stain)

a. Neurofibromatosis 1

b. Neurofibromatosis 2

c. Sturge weber syndrome

d. Tuberous Sclerosis

d. HHV-6

(will have very high fevers)

Cause of roseola

a. RSV

b. CMV

c. HPV

d. HHV-6

c. Still's

Vibratory/musical murmur

a. MVP

b. Venous hum

c. Still's

d. PDA

d. PDA

"Machinery-like" murmur

a. MVP

b. Venous hum

c. Still's

d. PDA

b. Reactivation/secondary TB

Cavity formation on CXR

a. Miliary TB

b. Reactivation/secondary TB

c. PJP pneumonia

d. Mycoplasma pneumoniae (walking pneumonia)

b. Bowen Disease

"Velvety red" lesion on penis

a. Communicating hydrocele

b. Bowen Disease

c. Peyronie's disease

d. SCC

a. Communicating hydrocele

Silk glove sign, "silk rubbing on silk"

a. Communicating hydrocele

b. Bowen Disease

c. Peyronie's disease

d. Spermatocele

c. Peyronie's disease

Dupuytren's contracture is assoc with

a. Communicating hydrocele

b. Bowen Disease

c. Peyronie's disease

d. Spermatocele

c. Angelman syndrome

"Happy puppet syndrome"

a. Marfan's syndrome

b. Prader-willi syndrome

c. Angelman syndrome

d. Ehler's danlos syndrome

b. Osteogenesis imperfecta

Blue-gray discoloration of sclera

a. Ehler's danlos syndrome

b. Osteogenesis imperfecta

c. DiGeorge syndrome

d. Noonan syndrome

d. Basilar skull fracture

Raccoon eyes, battle's sign

a. Temporal bone fracture

b. Epidural hematoma

c. Subdural hematoma

d. Basilar skull fracture

d. Congenital adrenal hyperplasia

(MCC of congenital adrenal hyperplasia = 21-hydroxylase deficiency; females present with clitoromegaly, labial fusion, & hyperpigmentation)

MCC pseudo precocious puberty

a. CNS lesion

b. Kallman syndrome

c. Adrenal tumor

d. Congenital adrenal hyperplasia

a. Ulcerative colitis

Crypt abscesses/crypts of Lieberkuhn & rectal involvement

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

c. Crohn's disease

Skip lesions, cobblestoning (usually rectal sparing)

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

b. IBS

Abdominal pain that IMPROVES with defecation

a. Ulcerative colitis

b. IBS

c. Crohn's disease

d. Diverticulitis

d. Li Fraumeni

Mutation on p53 that causes certain malignancies

a. Trisomy 13

b. Cowden

c. Fragile X

d. Li Fraumeni

b. Cowden

PTEN mutation that increases the risk for cancers

a. Trisomy 13

b. Cowden

c. Fragile X

d. Li Fraumeni

c. Richter

Hernias that involves the anti-mesenteric bowel

a. Bochdalek

b. Littre

c. Richter

d. Sliding

b. Amyand

(Appendix = Amyand)

Appendix in hernia

a. Littre

b. Amyand

c. Sliding

d. Bochdalek

a. Bochdalek

Congenital diaphragmatic hernia

a. Bochdalek

b. Littre

c. Richter

d. Sliding

d. Sliding

Portion of hernia sac is made up by viscus (bowel/bladder)

a. Bochdalek

b. Littre

c. Richter

d. Sliding

a. Littre

Meckel's diverticulum in an inguinal hernia

a. Littre

b. Amyand

c. Sliding

d. Bochdalek

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. Maternal lithium ingestion

Ebstein anomaly is commonly assoc with

a. Maternal lead ingestion

b. Maternal iron ingestion

c. Maternal alcohol ingestion

d. Maternal lithium ingestion

d. Treacher collins syndrome

(mandibular dystosis)

Beak-like nose, colobomas lower lid, small jaw

a. Angelman syndrome

b. Crouzon syndrome

c. Prader-willi syndrome

d. Treacher collins syndrome

b. HOCM

Anginal pain with exercise, "sudden death in young athlete"

a. Truncus arteriosus

b. HOCM

c. Tetralogy of fallot (ToF)

d. Hypoplastic left heart (HLH)

a. Fetal alcohol syndrome

Thin vermillion border of upper lip

a. Fetal alcohol syndrome

b. Ehlers danlos syndrome

c. 22q microdeletion

d. Williams syndrome

b. Aortic dissection

Pain + shock + pulsatile abd mass =

a. Wilm's tumor

b. Aortic dissection

c. DVT (Virchow's)

d. Pheochromocytoma

c. DVT (Virchow's)

Hypercoagulability + endothelial damage + venous stasis =

a. Wilm's tumor

b. Aortic dissection

c. DVT (Virchow's)

d. Pheochromocytoma

a. Acute bacterial prostatitis

Pain + prostate enlargement + failure to void =

a. Acute bacterial prostatitis

b. Chronic bacterial prostatitis

c. Chronic pelvic pain syndrome

d. Benign prostatic hyperplasia (BPH)

d. Benign prostatic hyperplasia (BPH)

Frequency/urgency + straining to void + drilling + incomplete bladder emptying + weak urine stream =

a. Acute bacterial prostatitis

b. Chronic bacterial prostatitis

c. Chronic pelvic pain syndrome

d. Benign prostatic hyperplasia (BPH)

d. Cystoscopy with biopsy

Bladder cancer gold standard imaging

a. UroFlow/EMG

b. TUS/doppler

c. CT scan abdomen/pelvis

d. Cystoscopy with biopsy

c. Gradual onset; cremasteric reflex present

(blue dot sign can be present, surgery not indicated)

Torsed appendage

a. Acute onset; cremasteric reflex present

b. Acute onset; cremasteric reflex NOT present

c. Gradual onset; cremasteric reflex present

d. Gradual onset; cremasteric reflex NOT present

b. Acute onset; cremasteric reflex NOT present

(SURGERYYYY within 6 hrs)

Testicular torsion

a. Acute onset; cremasteric reflex present

b. Acute onset; cremasteric reflex NOT present

c. Gradual onset; cremasteric reflex present

d. Gradual onset; cremasteric reflex NOT present

c. 11-12 y/o

TSEs should be done monthly starting at

a. 9-10 y/o

b. 10-11 y/o

c. 11-12 y/o

d. 12-13 y/o

b. 1 year

Infertility = the inability to conceive after ________ of unprotected intercourse

a. 6 months

b. 1 year

c. 2 years

d. 5 years

c. Testicular cancer

MC neoplasm in men aged 20-35 y/o

a. Prostate cancer

b. Bladder cancer

c. Testicular cancer

d. Penile cancer

c. Stress incontinence

Multiparous woman are at high risk for

a. Overflow incontinence

b. Urge incontinence

c. Stress incontinence

d. Mixed incontinence

a. Overflow incontinence

Assoc with urinary retention

a. Overflow incontinence

b. Urge incontinence

c. Stress incontinence

d. Mixed incontinence

d. Radionuclide bone scan

Hx prostate cancer followed by hip pain, what test is best to look for metastasis

a. CT scan

b. MRI

c. DEXA

d. Radionuclide bone scan

b. Mixed incontinence

Stress + urge incontinence =

a. Total incontinence

b. Mixed incontinence

c. Post-void residual

d. Overflow incontinence

c. In the cytoplasm of benign & malignant prostate cells

PSA is a glycoprotein produced..

a. In the cytoplasm of benign prostate cells

b. In the cytoplasm of malignant prostate cells

c. In the cytoplasm of benign & malignant prostate cells

d. In the cytoplasm of benign & malignant testicular cells