AAFP - Primary Care

Question 1

In which patients should you suspect pneumonia, and what is the best management for a 15 month old patient wit these signs?

Answer 1

Fever, cyanosis, and abnormal respiratory findings on physical exam (children in day care are at risk)

If child is not toxic appearing, dehydrated or hypoxemic, give oral high-dose amox with close outpatient f/u

Question 2

What is the appropriate treatment for midshaft posteromedial tibial stress fracture? (patient can walk without pain)

Answer 2

Air stirrup leg brace (aircast - pneumatic stirrup)

Casting NOT recommended

Question 3

What does low TSH in a patient with primary HoThyr receiving synthroid suggest? What should be done?

Answer 3

Indicates overreplacement, reduce dose slightly and repeat TSH levels in 2-3 months

Question 4

What determines progression to multiple myeloma in a patient diagnosis of MGUS?

Answer 4

Signs of end organ damage

Question 5

What is low dose estrogen OCP protective against?

Answer 5

Ovarian cancer

Question 6

Main S/S of polymyalgia rheumatica, and treatment?

Answer 6

Pain and stiff over shoulders and pelvic girdle, fever, night sweats high ESR

Responds dramatically to steroids

Question 7

What is the hallmark biochemical feature of refeeding syndrome?

Answer 7

Hypophosphatemia

Question 8

Indication for steroids in mono?

Answer 8

Signs of acute airway obstruction

Question 9

Which medications should be avoided in WPW syndrome? What can be given for cardio version ?

Answer 9

Any meds that block conduction through AV node should NOT be given (adenosine, digoxin, calcium channel blockers like verapamil)

Procainamide or Amiodarone

Question 10

What is the most important intervention to prevent spread of MRSA in nursing home?

Answer 10

Strict hand washing by all visitors and staff of the patient

Question 11

In which situations should metformin be withheld?

Answer 11

When there may be a temporary decrease in renal function that may cause lactic acidosis - I.e. IV contrast like during CTA

Question 12

In which situations should metformin be withheld?

Answer 12

When there may be a temporary decrease in renal function that may cause lactic acidosis - I.e. IV contrast like during CTA

Question 13

Risk of Welbutrin in preggos?

Answer 13

Spontaneous abortion

Question 14

What is sterile pyuria and dysuria in young female most suggestive of?

Answer 14

Chlamydja and gohnorrea or HSV

Question 15

What is the indication for 3 year follow up of colonoscopy?

Answer 15

3 or more tubular adenomas

Question 16

What is the primary treatment for symptomatic mitral valve prolapse?

Answer 16

Beta-blockers, eliminate caffeine and etoh,

Question 17

What is the treatment of altitude illness?

Answer 17

Acetazolamide, and dexamethasone for those with sulfa allergies

Question 18

Which drugs most likely cause interstitial nephritis?

Answer 18

Abx, mostly penicillins, cephalosporins, and sulfonamides,

Question 19

What is the most common cause of erythema multiforme?

Answer 19

Hypersensitivity reaction to HSV

Question 20

What are the signs of pyogenic tenosynovitis and how do you treat?

Answer 20

Pain, swelling, resistance to passive extension

Prevent spread in early stages with Abx and splinting, late stage tx requires surgery drainage + Abx

Question 21

What is a contraindication to using pioglitazone?

Answer 21

can cause fluid retention and therefore would not be a good choice for a patient with cardiomyopathy.

Question 22

What drugs should not be combined with sitagliptin initially?

Answer 22

Sulfonylureas

Question 23

What is scombroid poisoning?

Answer 23

pseudoallergic condition resulting from consumption of improperly stored scombroid fish such as tuna, mackerel, wahoo, and bonito.

Question 24

What is POTS and how do you treat?

Answer 24

Postural Orthostatic tachycardia syndrome, sudden tachy on standing (usually develops after viral illness, and associated with chronic fatigue),

adequate fluid and salt intake, followed by the initiation of regular aerobic exercise combined with lower-extremity strength training, and then the use of β-blockers.

Question 25

What initial tests should be done for an elderly patient with diabetes and decreased physical activity, who is about to undergo a vascular surgery procedure?

Answer 25

Non-invasive testing to determine risk of MI, via dipyridamole-thallium scan Coronary angio if abnormalities found

Question 26

What are the potential problems associated with long term omeprazole therapy?

Answer 26

Increased risk of community-acquired pneumonia and Clostridium difficile colitis, acutely decrease the absorption of vitamin B 12 , and it decreases calcium absorption, leading to an increased risk of hip fracture.

Question 27

What needs to be done for women over 35 years of age who experience abnormal vaginal bleeding?

Answer 27

endometrial assessment (via biopsy), to exclude endometrial hyperplasia or cancer

Question 28

What should pharmacotherapy with SSRIs be augmented with for treatment resistant depression?

Answer 28

Lithium or low-dose T3

Question 29

How should a patient presenting with cervical radiculopathy be managed?

Answer 29

respond well to NSAIDs without surgery

Question 30

What is intertrigo and erythrasma?

Answer 30

Intertrigo is inflammation of skinfolds caused by skin-on-skin friction. Erythrasma is caused by Corynebacterium minutissimum and presents as small reddish-brown macules that may coalesce into larger patches with sharp borders.

Question 31

How would you manage a thrombosed external hemorrhoid in the first 24 hours?

Answer 31

Thrombectomy under local

Question 32

What is a contributing factor to patellofemoral pain syndrome?

Answer 32

INadequate hip abductor strength

Question 33

What may be contraindications to prescribing Trazadone?

Answer 33

May cause sedation and orthostatic HoTN

Question 34

What should be given to a child with an asthma attack who has already received albuterol and corticosteroids and is still having breathing issues?

Answer 34

Magnesium sulfate IV

Question 35

Which hypoglycemic agent is best to use in patients with chronic kidney disease?

Answer 35

Glipizide

Question 36

How can you differentiate the symptoms of spinal stenosis vs. herniated disk?

Answer 36

In SS - Pain is relieved by sitting and aggravated by standing, whereas the opposite is true for pain from a herniated disk (better with standing worse with sitting aka flexed)

Question 37

What increases success of voiding trial in an elderly post-op pt with urinary incontinence?

Answer 37

Initiate alpha-blocker (Flomax-tamsulosin) with catheter insertion

Question 38

Which cardiac arrhythmia is associated with methadone use?

Answer 38

QT prolongation --> Torsades de Pointes

Question 39

What is the most sensitive test to do if suspecting genital HSV infection?

Answer 39

Viral PCR test

Question 40

What is the treatment for low-risk patients presenting with a-fib?

Answer 40

Aspirin 81-325 mg

Question 41

What is the appropriate therapy for venous ulcers?

Answer 41

Pentoxifylline is effective when used with compression therapy for venous ulcers

Question 42

What is the most worrisome early sign of anaphylaxis?

Answer 42

Pruritus around the mouth and on the palms of the hands and soles of the feet

Question 43

What is the most common cause of abnormal liver enzymes in the developed world>

Answer 43

Non-alcoholic fatty liver disease

Question 44

What should you suspect in patients suffering from a critical illness with an exaggerated inflammatory response?

Answer 44

Cortisol deficiency, give corticosteroids

Question 45

Which drug is least likely to produce dangerous side effects in an elderly patient with low back pain?

Answer 45

Lidoderm - lidocaine patch, low systemic absorption

Question 46

What is the appropriate management of chronic neck pain?

Answer 46

Complete cervical spine series followed by MRI if neurological signs present

Question 47

What is the centor criteria?

Answer 47

most reliable clinical predictors of streptococcal pharyngitis - tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever (3/4 test and treat if +, 4/4 treat)

Question 48

What is the best treatment for recurrent migraines for children

Answer 48

Propranalol

Question 49

What is the most common cause of abnormal liver enzymes in the developed world>

Answer 49

Non-alcoholic fatty liver disease

Question 50

What should you suspect in patients suffering from a critical illness with an exaggerated inflammatory response?

Answer 50

Cortisol deficiency, give corticosteroids

Question 51

Which drug is least likely to produce dangerous side effects in an elderly patient with low back pain?

Answer 51

Lidoderm - lidocaine patch, low systemic absorption

Question 52

What is the appropriate management of chronic neck pain?

Answer 52

Complete cervical spine series followed by MRI if neurological signs present

Question 53

What is the centor criteria?

Answer 53

most reliable clinical predictors of streptococcal pharyngitis - (3/4 needed) tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever

Question 54

What is the best treatment for recurrent migraines for children

Answer 54

Propranalol

Question 55

What NSAID should be avoided in elderly patients and why?

Answer 55

Indomethacin due to high rates of adverse CNS effects

Question 56

Best medication to treat nausea in pregnant women?

Answer 56

Doxylamine and vitamin B6

Question 57

What is the treatment of Rosacea?

Answer 57

avoidance of precipitating factors and use of sunscreen. Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms.

Question 58

How does lichen planus appear and how do you treat?

Answer 58

violaceous flat-topped papules, usually 3–6 mm in size high-potency topical corticosteroids such as clobetaso

Question 59

Which should be considered in a patient being treated with appropriate antibiotics for complicated UTI who has persistent fever and flank pain?

Answer 59

Get CT abdomen to look for peri nephric abscess

Question 60

What is the preferred imaging modality when suspecting septic arthritis?

Answer 60

Ultrasonography to detect effusions etc.

Question 61

What is the female athlete truant and what evaluations may need to be done in such patients?

Answer 61

amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture resulting from minimal trauma May require evaluation for pregnancy, progestin challenge of suspecting secondary amenorrhea and bone scan for fracture

Question 62

What should be given for persistent vfib along with CPR and defibrillation?

Answer 62

vasopressor, which can be either epinephrine or vasopressin.

Question 63

What are the Radiographic features of a benign pulmonary nodule?

Answer 63

diameter

Question 64

What is fibromyalgia syndrome and how do you best treat?

Answer 64

Depression, pain and sleep disturbance in patients with fibromyalgia TCA and duloxetine

Question 65

What is the best management for foot problems in elderly patient (e.g. Bunyons, ulcers, Hammer toes etc.)?

Answer 65

Palliative care, like special shoes and pads

Question 66

What is the best ppx Abx for travelers diarrhea?

Answer 66

Rifaximin

Question 67

What are patients in end stage renal failure who receive gadolinium enhanced MRI at risk for?

Answer 67

gadolinium-associated nephrogenic systemic fibrosis

Question 68

What are the markers of gestational diabetes and how do you best treat?

Answer 68

Fasting glucose >100 and post meal >140 Try diet and exercise, if still problem, add A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily

Question 69

What is a side effect of geodon and what can exacerbate this?

Answer 69

QT prolongation, which can worsen with Abx like Clarithromycin, anti arrhythmics, and TCAs

Question 70

What should be given to a patient with STEMI being evaluated for reperfusion therapy?

Answer 70

Oral clipidogrel and chew 162-325mg Aspirin

Question 71

What is the greatest risk factor for developing T2DM?

Answer 71

Gestational diabetes

Question 72

What is a Dupuytren's contracture?

Answer 72

Changes in the palmar fascia, with progressive thickening and nodule formation that can progress to contracture of associated finger (commonly 4th finger, pitting or dimpling over nodule)

Question 73

What medications can cause acute dystonic reaction, and how do you best treat?

Answer 73

any agent that blocks dopamine, including prochlorperazine, metoclopramide, and typical neuroleptic agents such as haloperidol. The acute treatment of choice is diphenhydramine or benztropine

Question 74

Which classes of diabetes medications acts primarily by stimulating pancreatic insulin secretion?

Answer 74

Sulfonylureas and meglitinides stimulate pancreatic insulin secretion (like Glipizide)

Question 75

What is the best treatment for isolated hirsutism in premenopausal females?

Answer 75

Androgen inhibitors like spirinolactone along with OCPs

Question 76

What are the most likely signs of retinal detachment?

Answer 76

patient complaining of flashes of light and a visual field defect