AAFP Mixed 7

Question 1

OTC an with SSRI can cause serotonin syndrome?

Answer 1

Dextromethorphan (cold medicine)

Question 2

most appropriate initial test to rule out adrenal insufficiency is

Answer 2

morning serum cortisol

Question 3

necessary symptom to make a diagnosis of polymyalgia rheumatica?

Answer 3

# bilateral shoulder or hip stiffness 
#ESR over 40

Question 4

Importance of frequent PVCs in patient without known heart disease? Work up?

Treatment of PVCs?

Answer 4

acute myocardial infarction and sudden death; Evaluation for CAD

None - treatment associated with higher mortality

Question 5

Pt presents after fall on outstretched hand. Tenderness of the radial head without significant swelling. Imaging shows no fracture, but a positive fat pad sign. Diagnosis? Tx?

Answer 5

Nondisplaced radial head fractures.

#posterior splint for 1 week
#then early mobilization and a sling

Question 6

only hypoglycemic agent shown to reduce mortality rates

Answer 6

Metformin

Question 7

acceptable increase in liver enzymes on statin?

Answer 7

3-fold (to 75+)

Question 8

painful thyroid gland, hyperthyroidism, and an elevated erythrocyte sedimentation rate - diagnosis? tx?

Answer 8

subacute thyroiditis; symptomatic treatment (steroids)

Question 9

Scuba diver presents with episodes of vertigo with straining. Diagnosis?

Answer 9

perilymphatic fistula between the middle and inner ear (from barotrauma)

Question 10

initial test for child with septic hip?

Answer 10

Ultrasound

Question 11

female athlete triad ?

Answer 11

amenorrhea, osteoporosis, and disordered eating

Question 12

treatment of narrow complex, regular tachycardias? Do not use for?

Answer 12

Adenosine; V-FIB

Question 13

treatment for VFIB?

Answer 13

#CPR/electrical defibrillation 
#vasopressor (Epinephrine or vasopressin)
#Amiodarone if all else fails

Question 14

Test to diagnosis renal colic?

Answer 14

CT (better than US)

Question 15

Management of maternal hypothyroid during pregnancy?

Answer 15

Increase levotyroxine

Question 16

Likelihood ratios indicate ?

Answer 16

how a positive or negative test correlates with the likelihood of disease

Question 17

most common initial symptom of Hodgkin lymphoma?

Answer 17

painless lymphadenopathy

Question 18

Pseudoaddiction?

Answer 18

patient behaviors that may occur when pain is undertreated

Question 19

Gottron’s papules?

Answer 19

#flat-topped, sometimes violaceous papules 
#seen on most knuckles

Question 20

Molecule that confirms a vitamin D deficiency?

Answer 20

25-hydroxyvitamin D&raquo_space; 1,25-Dihydroxyvitamin D (levels can vary with secondary hyperparathyroidism)

Question 21

antibiotic shown to reduce the risk for traveler’s diarrhea

Answer 21

Rifaximin

Question 22

When to give antiviral treatment of influenza patients?

If pt presents with clinical deterioration requiring hospitalization?

Answer 22

Within 48 hours (otherwise don’t give)

Start antivirals even if over 48 hours since onset

Question 23

Workup of incidental adrenal mass?

Answer 23

# dexamethasone suppression test
#24-hour fractionated metanephrines and catecholamines
#If HTN, morning plasma aldosterone activity and plasma renin
#In nonfunctional - CT, MRI and/or scintigraphy

Question 24

Diagnostic test for gadolinium-associated nephrogenic systemic fibrosis?

Answer 24

skin biopsy

Question 25

gestational DM - keep glucose under?

Answer 25

100;

#Lifestyle modifications
#insulin therapy

Question 26

STEMI is defined as?

Answer 26

ST-segment elevation of greater than 0.1 mV in at least two contiguous precordial or adjacent limb leads

Question 27

Dupuytren’s contracture presents with? finger most affected?

Answer 27

progressive thickening of palmar fascia (can be nodular)

fourth

Question 28

Rash of Juvenile rheumatoid arthritis?

Answer 28

salmon-pink maculopapular rash

Question 29

Combination of arthritis with palpable purpuric rash in child consistent with?

Answer 29

HSP