2021 Practice Exam Flashcards by Deleted Deleted

List two point-of-care tests for group A strep.

Rapid antigen testing

Nucleic acid detection

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List 5 symptoms of hypothyroidism.

Brittle hair/nails
Weight gain
Depression
Cold intolerance
Dry skin

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What are three limitations of point of care group A strep tests?

Cannot distinguish between carrier and active infection
Cannot determine virulence
Cannot determine abx sensitivity

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What are three benefits of antibiotic treatment for group A strep?

Reduced symptoms and reduced duration
Decrease instance of secondary infections (AOM, Peritonsillar abscess, sinusitis)
Decreased incidence of rheumatic fever

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List 5 symptoms of hypothyroidism.

Brittle hair/nails
Weight gain
Depression
Cold intolerance
Dry skin
Constipation

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What is the definition of sub-clinical HTN? 4 items.

TSH 4-10
Normal T3
Normal T4
Asymptomatic

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In what 4 cases should acupuncture be avoided?

Radicular back pain
Local infection
Non-licensed
Non-sterile

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What are five non-drug therapies for low back pain?

Stretching
Heat
Ice
Massage
Yoga

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What percentage of patients with ASD suffer from sleep abnormalities?

75%

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What are five common sleep abnormalities associated with ASD?

Onset latency
Poor sleep efficiency
Early waking
Prolonged sleep
Somnambulism

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What two treatments are effective for improving sleep in ASD?

CBT

Melatonin

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What are 5 risk factors for social isolation, social vulnerability and loneliness?

Increased age
Living alone
Female sex
Sensory loss
Low income
Living far from family
LTC
Few friends
No transport

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What effect might social isolation have on a patient’s health?

Increased morbidity and mortality

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What are the four geriatric giants?

Immobility
Incontinence
Instability
Impaired memory/intellect

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What are three signs of Wernicke’s encephalopathy?

Confusion
Ataxia
Opthalmoplegia

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What is the management for Wernicke’s encephalopathy?

Thiamine

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Why do we give thiamine prophylactically to EtOH patients?

To prevent Wernicke’s encephalopathy.

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What three conditions are associated with thiamine deficiency?

Wernicke’s encephalopathy
Beriberi
Korsakoff’s syndrome

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What two non-pharm substances should be avoided in patients taking opioids?

Cannabis

Alcohol

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What two OTC should all heavy smokers take?

Vit D

Calcium

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New 65 year old male heavy smoker comes to office. What non-lab screening tests do you order?

Flex sig
Low dose CT thorax
U/S abdo for AAA

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What 4 vaccinations do you offer 65+ male

PSV-13
PPSV-23
Flu
Tdap

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What are 4 teratogenic effects associated with anti-seizure medications?

Neural tube defects
Lower IQ scores
Heart malformation
Cleft lip and palate
Low birth weight
Urogenital defects

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What is the recommended dose of folic acid supplementation during pregnancy for women at high risk of defects?

4 mg

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What effect does estrogen have on valproate?

Estrogen increases the breakdown of valproate.

How long does somebody need to be seizure free before getting pregnant?

9 months

What are 5 things to do before the start of every pregnancy?

``` Cannabis cessation Smoking cessation Alcohol cessation Medication review Folic acid ```

List 5 causes of alternating diarrhea and constipation.

``` IBS Crohn's UC Celiac disease Gastroenteritis ```

What test is best to differentiate IBS from IBD?

Fecal calprotectin.

What are two medications to treat IBS?

TCA's - diarrhea | SSRI's - constipation

What are the four categories of fecal incontinence?

Urge Passive Involuntary Seepage

What are two non-pharmacologic strategies to treat fecal incontinence?

Dietary changes | Reduce barriers

What are 4 classes of medications that may cause diarrhea?

``` Biguanides Magnesium Antibioitcs PPI Calcium channel blockers Antifungals ```

What diagnosis would you suspect with a rash that starts in between the toes and progresses to the dorm of the foot with scale?

Tinea pedis.

What are three complications of tinea pedis?

Secondary infection Asthma flares Eczema flares

What is the most effective treatment for tinea pedis?

Topical terbinafine

What are three times you should you use an oral agent for tinea pedis?

Immunosuppressed Failed topical Severe disease

What are four side effects with the ketogenic diet?

``` Gastrointestinal discomfort GERD Nausea Vomiting Diarrhea Constipation Dyslipidemia ```

What are 3 benefits of the ketogenic diet

Decreased HbA1c Decreased need for insulin Weight loss

What one condition benefits from the ketogenic diet?

Epilepsy

What one test do you order if you suspect lithium toxicity?

Serum lithium level

What 3 things may effect lithium level?

Treatment adherence Drug interactions Age Comorbid conditions

What are four occasions where you check lithium levels?

3-6 days after initiation If there is a dosage change If you suspect toxicity q3-6 months regardless

What are 5 parameters you would follow for a patient on lithium?

``` Lithium level Serum sodium Serum urea Serum creatinine Calcium level TSH Weight ```

What two conditions are associated with pediatric atopic dermatitis?

Asthma | Allergies

What are two recommendations you would make regarding diet for a 5 month old child?

Introduce allergens Introduce allergens one food at a time Introduce iron containing foods

List four foods you would want to introduce to a 5 month child.

Eggs Milk Peanuts Wheat

What is the ideal age range to introduce allergens?

4-6 months

What is the most concerning side effect with aromatase inhibitors (breast cancer chemo)?

Osteoporosis

What drug class reduces the risk of breast cancer recurrence in bone as well as mortality in menopausal women?

Bisphosphonates

What four things should you screen a patient with cancer for?

Depression Fatigue Anxiety Pain

How often should a post breast cancer patient be reviewed?

q6months

What three things should be done post breast cancer at each visit?

Clinical exam Screen for mental health Side effects of therapy

When should a post-breast cancer patient have a mammogram?

q12 months

What five lifestyle recommendation should you make for a post-breast cancer patient?

``` Exercise Smoking cessation Alcohol reduction Maintain healthy weight Monthly self breast exam ```

What two medications are most associated with a hypoglycemic event?

Sulfonureas | Insulin

What is the biggest risk for a hypoglycemic event in a diabetic?

Age

What indication must you have for chronic non-cancer opiate use?

All other therapies have failed

If a patient has almost constant pain (day and night) what formulation of narcotic analgesia is appropriate?

Sustained release

What diagnosis do you suspect with repetitive strain injury worse with wrist extension?

Lateral epicondylitis

What recommendation do you have for PRP injections?

Don't

What treatment is associated with a reduction in pain in lateral epicondylitis?

Physiotherapy

What is the prognosis for lateral epicondylitis if left untreated?

90% self resolve by 12 months

What three things are diagnostic for familial hypercholesterolemia?

Tendon xanthomas LDL-C < 8.5 Known DNA mutation

What lab finding would make you suspicious for familial hypercholesterolemia?

LDL-C > 5 in patients over 40 | LDL-C > 4 in patients under 18

What are three things on personal history/physical exam that would make you suspicious for colon cancer?

``` Melena Hematochezia Constitutional symptoms Abdominal mass Rectal mass ```

What are 5 treatments (pharm/non-pharm) for IBS?

``` Low-FODMAP Increase fluid Soluble fibre Anti-spasmodics TCA's SSRIs ```

What 5 medications would you expect a patient with diabetes and a history of MI to be on?

``` ACE beta-blocker Statin Metformin SGLT2i ```

What are 5 classes of medications you would stop on a sick day?

``` Sulfonureas ACE Diuretics Biguanide ARB NSAIDs SGLT2i ```

What two diabetic medications have cardioprotective effects?

GLP1 agonists | SGLT2 inhibitors

What are 5 benefits of GLP1 agonists/SGLT2i?

``` Decreased CV complication Decreased CV mortatliy Weight loss BP lowering Nephroprotective ```

What are 5 side effects associated with SGLT2i?

``` Increased urinary frequency Increased urinary volume Orthostasis Genital candidiasis UTIs Decreased GFR ```

What two parameters should be assessed after initiation of an SGLT2i at 2-4 weeks?

eGFR | Potassium

What therapy should be initiated in pregnancy to reduce pre-eclampsia?

Low dose ASA

When is the optimal time to initiate aspirin to reduce pre-eclampsia?

< 16 weeks

What are three risk factors for pre-eclampsia?

Obesity Previous gestational diabetes Older age

When is the best time to deliver a patient who is pregnant and obese?

Before 39 weeks

When should a c-section be considered in an obese patient?

If projected birthweight is > 5kg

What additional imaging tests should be done in an obese patient?

U/S @ 28, 32, 36 weeks | Weekly after 37

What are 5 causes of tremor?

``` Beta-agonist use Corticosteroid use Essential tremor Physiological tremor Alcohol withdrawal Caffeine intake ```

What are three symptoms of Parkinson's?

Pill rolling tremor Bradykinesia Rigidity

What is one treatment you wouldn't use for Parkinson's? | What is one you would?

Don't use amantadine | DO use carbodopa/levopoda.

What are 5 causes of Kussmal breathing in children?

``` Metabolic acidosis Heart failure Croup Bronchitis Pneumonia Uncontrolled asthma Renal failure Sepsis Anxiety ```

What is the causative agent for Molluscum?

Poxvirus

How does one continue to get infected by molluscum?

Autoinnoculation

What is the one best treatment for molluscum? | What are two others

Cantharidin Curettage Cryo Observation

What are three adjustments you can make to help with absorption of medications following bariatric surgery?

Switch solid to liquid Switch XR to IR Non-oral formulations Less first pass metabolism

How frequently do you review a bariatric patient post surgery?

q2-4 weeks until weight stabilizes

What are three features of sensorineural hearing loss?

Gradually progressive Worse at high frequencies Worse in noisy environments

What diagnosis would you suspect with patchy circular hair loss?

Alopecia areata

What age range is alopecia aerate most prevalent?

1-17 years

What are 3 treatments for alopecia areata?

``` Steroids Topical midoxinil Topical bimatoprost Cyclosporine Azathiprine PRP ```

Which four routes are effective for steroid use for alopecia aerata?

Topically Intralesionally Orally IV

What tool could you use to assess disease burden of OA severity?

Lequesne index

What is one non-parenteral medication for OA?

Intra-articular steroid injection

In decreasing order of severity, what are 4 types of homelessness?

Unsheltered Emergency sheltered (Sal's army) Provisionally accommodated Precariously housed (couch surfing)

What are 3 reasons somebody may not be able to make it to an appointment?

``` Hours of operation Transport Child care Mental barriers Lack of phone ```

What are 4 things to help the homeless?

``` Income assistance Access to housing Social worker Substance use programming Mental health services ```

What are 6 symptoms of Kawasaki disease?

``` Fever Conjunctivitis Rash Adenopathy Oral changes (strawberry tongue) Hand/Foot involvement ```

What complication do you look out for in Kawasaki disease?

Coronary Artery Aneurysm

How do you treat Kawasaki disease?

ASA | IVIG

In a child who you suspect Kawasaki disease, but they don't have 4/5 symptoms, what would you call the diagnosis?

Incomplete Kawasaki disease

What two antibody screening should be done at the first pre-natal visit?

ABO | Rh

What antibodies are most commonly associated with hemolytic disease of the fetus and newborn?

Anti-C,D,E Kell

What are three circumstances that increase risk of the mother developing antibodies?

Blood transfusion Pregnancy Maternal fetal hemorrhage

What test should you order if a pre-natal patient has weak RhD antibodies?

RhD genotyping

What are three tests if you suspected hemolytic disease of the newborn?

Hemoglobin Reticulocyte count Blood film Indirect bilirubin

What test is unsuitable for screening of neonatal jaundice?

Coomb's test

If there is an elevated unconjugated bili, what tests need to be normal to rule out hemolytic disease of the newborn?

Normal hgb Normal reticulocyte Normal blood film

What one condition are you worried about if there is fetal-maternal incompatibility

Hemolytic disease of the newborn

What process do we try and prevent with winRho?

Alloimmunization

List 5 causes of maternal fetal hemorrhage.

``` Abdominal trauma Delivery Spontaneous abortion Therapeutic abortion Crodocentesis Chorionic villous sampling Amniocentesis External Cephalic Version ```

What is the dose of WinRho?

300 micrograms

What test do you order if you suspect varicella zoster or herpes zoster?

Viral PCR

What complication do you worry about in elderly with herpes zoster or varicella zoster?

AKI

What precautions should somebody infected with varicella zoster be placed under?

Airborne

When is somebody with varicella zoster no longer contagious?

When the lesions have crusted over

What is the active ingredient in the IUS?

levonorgestrel

What two treatments can reduce the pain of IUD insertion?

4% topical lidocaine 600 micrograms of misoprostol Lidocaine-prilocaine cream

What are the two first line treatments for alcohol use disorder? Which is better for cravings? Which is better for abstinence?

Acamprosate - abstience | Naltrexone - cravings

What are two second line treatments for alcohol use disorder?

Gabapentin | Topiramate

What are two indications for multi-vitamins?

Alcohol use disorder Compromised nutritional status Macular degeneration

Which three OTC do not have great evidence in otherwise healthy elderly?

ASA B12 Multivitamin

What happens when you give amoxicillin to mononucleosis?

Amoxicillin rash

List 5 side effects of antibiotics

``` Nausea Vomiting Bloating Abdominal pain Diarrhea C. diff Allergy ```

List 3 antibiotics that are most likely to cause C. difficile infections.

``` Clindamycin Ampicillin Amoxicillin Levofloxacin Moxifloxacin ``` Think CALM the gut

Broad spectrum antibiotics are associated with overgrowth of what organism?

Candida

What is called when somebody is pathologically scared of getting cancer again?

Fear of cancer recurrence (FCR)

What is the scale for measuring patient worry about cancer recurrence?

Fear of Cancer Recurrence inventory

List 5 antibiotics that can be used for oral treatment of cystic acne

``` Doxycycline Tetracycline Clindamycin Keflex Azithromycin Erythromycin SMP-TMX ```

What drug class for cystic acne is most associated with hypersensitive reactions and autoimmune disorders?

Tetracyclines

What two populations should not get tetracyclines?

Pregnant persons | Children under 8 years

List 5 symptoms of ADHD

``` Inattention Impulsiveness Hyperactivity Forgetfulness Distractibility Poor academic performance Behavioural problems ```

What are 5 other diagnoses that should be on your differential when considering a diagnosis of ADHD?

``` ODD tic disorder Substance use disorder Anxiety Depression Autism spectrum disorder Learning disorder Intelectual disability ```

What are three gestational risk factors for ADHD?

Low birth weight Maternal alcohol use Maternal smoking

What are two first-line treatments for ADHD?

Methylphenidate | Amphetamine

What is the number one risk factor for ADHD?

Family history

What should you screen for before prescribing a stimulant for ADHD?

Risk factors for sudden cardiac death

List 5 risk factors for pneumothorax.

``` Previous pneumothorax Asthma Emphysematous bleb Tobacco use Congenital abnormalities ```

What is the definitive management for pneumothorax?

Chest tube

What is the most common complication following pneumothorax?

Recurrence

What are three risk factors for developing OA?

Occupation BMI Previous injury

What is the most effective treatment for OA pain?

Exercise

What are 3 side effects of BZRAs?

Physical dependence Falls Memory Sleep quality

How much sleep do the elderly need?

7-8 hours

What are 3 interventions to improve sleep hygiene?

Avoid caffeine before bed Avoid alcohol before bed Avoid electronics before bed

In a child with a swollen joint what are 4 diagnoses you should consider?

Septic arthritis Juvenile idiopathic arthritis Acute reactive arthritis Lyme disease

What is the treatment for lyme disease?

Doxycycline

What is the complication associated with missed DKA?

Cerebral injury

What are four parameters for diagnosing DKA?

Elevated BGM Low pH Ketonemia or Ketonuria Low Bicarb

What are 5 precipitants for DKA?

``` Febrile illness Gastro Eating disorder Alcohol Cannabis ```

What is the first step in management in pediatric DKA?

Bolus normal saline 10 mg/kg

What are four side effects of hearing loss in elderly?

Falls Social isolation Mental illness Cognitive decline

If a patient exhibits improvement with hearing aids, what second device could you offer?

Cochlear implants

What are red flags of hearing loss?

Sudden onset Head trauma Neurologic findings

What diagnosis would you suspect if you saw a rash in a 6 year old as well as abdominal pain and fever?

Henoch Schonlein purpura

What is the pathophysiology of Henoch Schonlein purpura?

IgA mediated vasculitis

What is one long term complications associated with henloch schonlein purpura?

Renal injury