AAFP

Question 1

A child under 2 with fever, cyanosis, and any abnormal respiratory finding in the history or physical examination.
Dx?
Tx?

Answer 1

Streptococcus pneumoniae is one of the most common etiologies in this age group, and high-dose amoxicillin is the drug of choice.

Question 2

At what age does the extrusion reflex (pushing foreign material out of the mouth with the tongue) go away in children?

Answer 2

4mo, so begin introducing solid food at 4-6mo

Question 3

recommendation for the initial screening test for late-onset male hypogonadism.

Answer 3

Free testosterone

Question 4

68-year-old African-American female with primary hypothyroidism is taking levothyroxine (Synthroid), 125 μg/day. Her TSH level is 0.2μU/mL (N 0.5–5.0). She has no symptoms of either hypothyroidism or hyperthyroidism.

Which one of the following would be most appropriate at this point?

Answer 4

In a patient receiving levothyroxine, a low TSH level usually indicates overreplacement. If this occurs, the dosage should be reduced slightly.

Question 5

A 40-year-old female obese nurse comes to your office with a 1-month history of right heel pain that she describes as sharp, searing, and severe. The pain is worst when she first bears weight on the foot after prolonged sitting and when she gets out of bed in the morning. It gets better with continued walking, but worsens at the end of the day.
Dx and tx?

Answer 5

Dx - plantar faciitis

Tx - OTC heel inserts

Question 6

Tx for HSV-1

Answer 6

acyclovir

Question 7

Most sensitive test for ACL injury

Test used to detect meniscal injury

Answer 7

Lachman

McMurray

Question 8

Diabetic polyneuropathy is characterized by what type of sensory and motor deficits?

Answer 8

Symmetric and distal limb sensory and motor deficits

Question 9

What may be secondary to diabetes mellitus, but is manifested by numbness and paresthesia over the anterolateral thigh with no motor dysfunction.

Answer 9

Meralgia paresthetica, or lateral femoral cutaneous neuropathy

Question 10

causes pain in the legs, but is not associated with the neurologic signs or with knee problems.

Answer 10

Spinal stenosis

Question 11

What is a relatively common complication of diabetes mellitus, may produce intermittent claudication involving one or both calf muscles but would not produce the motor weakness noted in this patient.

Answer 11

Iliofemoral atherosclerosis

Question 12

Women who use low-dose estrogen oral contraceptives have a 50% lower risk of cancer of the ___

Answer 12

ovary

Question 13

A woman over 50 with pain and stiffness in the shoulder and pelvic girdle. 4%–13% of patients with this have a normal erythrocyte sedimentation rate (ESR). As many as 5% of patients initially have a normal ESR that later rises.
A variety of systemic symptoms. Fever is common, with temperatures as high as 39°C (102°F) along with night sweats. Additional symptoms include depression, fatigue, malaise, anorexia, and weight loss.
What is the dx and tx?

Answer 13

Dx - polymyalgia rheumatica

Tx - CS

Question 14

hallmark biochemical feature of refeeding syndrome is __

Answer 14

hypophosphatemia

Question 15

Valsalva maneuver will typically cause the intensity of a systolic murmur to increase in patients with which one of the following conditions?

Answer 15

Hypertrophic obstructive cardiomyopathy

The Valsalva maneuver decreases venous return to the heart, thereby decreasing cardiac output. This causes most other murmurs to decrease in length and intensity. The murmur of hypertrophic obstructive cardiomyopathy, however, increases in loudness. The murmur of mitral valve prolapse becomes longer, and may also become louder.

Question 16

A 12-year-old male presents with left hip pain. He is overweight and recently started playing tennis to lose weight. He says the pain started gradually after his last tennis game, but he does not recall any injury. He is walking with a limp. On examination he is afebrile and has limited internal rotation of the left hip.

MC hip disorder in this age group?

Answer 16

Slipped capital femoral epiphysis

Question 17

Best test for dx of COPD

Answer 17

spirometry - the pressure of outflow obstruction that is not fully reversible is demonstrated by postbronchodilator spirometry showing an FEV1/FVC ratio of 70% or less.

Question 18

A 20-year-old female asks you whether she should have a colonoscopy, as her father was diagnosed with colon cancer at the age of 58. There are no other family members with a history of colon polyps or cancer.

You recommend that she have her first screening colonoscopy

Answer 18

at age 40 and then every 5 years

OR 10 years before earlies age at which affected relative dx

Question 19

What classifies a high risk group for colorectal cancer?

Answer 19

one 1st degree relative dx w/ colorectal ca or adenomatous polypos before 60y

OR

two 2nd degree relative with colorectal ca

Question 20

Hydralazine, procainamide, and quinidine all cause what lung problem?

Answer 20

lupus pleuritis

Question 21

adenosine, digoxin, and CaCB should not be given to W-P-W syndrome bc…?

what is the DoC?

Answer 21

block conduction through the AVnode, which may increase the ventricular rate paradoxically, initiating ventricular fibrillation.

procainamide or amiodarone

Question 22

Which one of the following is contraindicated in the second and third trimesters of pregnancy? 
 A. Amoxicillin 
 B. Azithromycin (Zithromax) 
 C. Ceftriaxone (Rocephin) 
 D. Ciprofloxacin (Cipro) 
 E. Doxycycline

Answer 22

doxycycline - teeth discoloration

Question 23

You have just diagnosed mild persistent asthma in a 13-year-old African-American female. Along with patient education, your initial medical management should be

Answer 23

Low Dose-CS daily and SABA prn

Question 24

What three things should pts (i.e. for RA) be screened for before starting on monoclonal antibody class (infliximab, adalimumab, certolizumab pegol, and golimumab)

Answer 24

TB, Hep B, Hep C

Question 25

Metformin (Glucophage) should be stopped prior to which one of the following, and withheld until 48 hours after completion of the test?  
 A. An upper GI series 
 B. Abdominal ultrasonography 
 C. CT angiography 
 D. MRI of the brain 
 E. Colonoscopy

Answer 25

C - a temporary reduction in renal function, such as occurs after pyelography or angiography, can cause lactic acidosis in patients taking metformin, the drug should be discontinued 48 hours before such procedures (SOR C) and restarted 48 hours after the procedure if renal function is normal.

Question 26

Nursing home–acquired pneumonia (fever, difficulty breathing, and a cough productive of purulent sputum. O2 sat 86%.

Tx (three)

Answer 26

Ceftazidime, levofloxacin (anti pseudomonal), and vancomycin (anti MRSA)

Question 27

is fluoxetine or paroxetine safe for preg?

Answer 27

fluoxetine

Question 28

____ is indicated for the treatment of severe osteoporosis, for patients with multiple osteoporosis risk factors, or for patients with failure of bisphosphonate therapy

Answer 28

Teriparatide

Question 29

Recommended age ranges for M v F in aspirin use

Answer 29

M: 45-79
F: 55-79

Question 30

CBC reveals a mild microcytic, hypochromic anemia with RBC poikilocytosis, but is otherwise normal. The RBC distribution width is also elevated.
Of the following, the most appropriate next step would be to:

Answer 30

oral iron supplementation

Question 31

3 day old infant who does not appear to be irritable or in distress, and she is afebrile and feeding well. On examination, abnormal findings are confined to the skin, including her face, trunk, and proximal extremities, which have macules, papules, and pustules that are all 2–3 mm in diameter.

Answer 31

Erythema toxicum neonatorum

Question 32

Colonoscopy screening:

• Normal interval:
• Patients with one or two small tubular adenomas:
• Patients with three or more tubular adenomas:

Answer 32

• Normal interval: 10 years
• Patients with one or two small tubular adenomas (5–10 years)
• Patients with three or more tubular adenomas (3 years)

Question 33

primary treatment for symptomatic mitral valve prolapse is ____

Answer 33

primary treatment for symptomatic mitral valve prolapse is β-blockers (olol)

Question 34

Acetazolamide v. dexamethasone in preventing altitude sickness

Answer 34

• Acetazolamide contraindicated in sulfa drug allergy

- Dexamethasone is not contraindicated.

Question 35

penicillins, cephalosporins, and sulfonamides, are the most common drug-related cause of what kidney injury?

Answer 35

acute interstitial nephritis