AAFP Questions Flashcards
Site for emergency tracheostomy
Directly above the cricoid cartilage, through the cricothyroid membrane.
Retinal Vein occlusion
- Sudden Painless loss of vision. no redness. HTN and DM are RF. Will see dilated and torturous veins on fundo
What can cause false positives for opioids
Ibuprofen, Diphenhydramine, Dextrometharphan, fluroquinolones
Secondary amenorrhea
No period for 3 months or irregular period for 6 months. Warrants FSH and LH work up
Colonoscopy screening in IBD
10 years after diagnosis and repeat 2-5 years
In which patients tramadol should be avoided in?
Seizures
Treatment of Rosacea
Doxycycline
Chronic midsubstance Achilles tendinitis
It is >6 weeks
Eccentric exercise involving gastronemius and soleus muscle
Which EKG abnormality cannot be evaluated with treadmill stress test?
LBBB can lead to false positives.
Which 2 rashes are similar (1 is STD)
Rocky mountain fever and Syphilis
Conditions that reduce INR and need HIGHER coumadin dose
Hypothyroidism, diabetes, hyperlipidemia, visceral carcinoma
Conditions that increase INR and need LOWER coumadin dose
- Skinny (malnutrition, hyperthyroidism, hypermetabolic state, scurvy, anorexia)
- Kidney, liver function bad. Heart failure
- Fever, Infxn
Palavizumab indications
- Born before 29w GA and <1y of age at the beginning of RSV season, or less than 32w GA who develop chronic lung disease of prematurity. After >1y, only if infants have chronic lung disease of prematurity requiring intervention
Maternal benefits of breast feeding
Cardiometabolic (Diabetes, HTN)
Ovarian and breast ca
PP depression
Athlete Triad
Disordered menses, low bone density and less energy compared to calories burnt.
PVCs
PVC burden of >10% can cause dilated CMpathy. Evaluate with echo. Should be treated with anti-arrhythmetics.
Hep A Prophylaxis
1-40y: Vaccine only
<1: Immunoglobulin
>40/ immunocomp: Vaccine and immunoglobulin
Pityriasis Versicolor
Tx: Selenium sulfide (others are miconazole, terbinafine)
MODY (Mature onset diabetes in young age)
Patients who are young, not fat and have preserved pancreatic B cell function. Dont respond to metformin but do to sulfonylureas
Whooping Cough in adults
Non-specific URI with intense coughing following. Nasopharyngeal swab and PCR. Azithro not to treat but reduce transmission.
What factors used in BP in kids
height (cuff size), sex and age
What is associated with prolonged recovery in concussions?
headaches lasting longer than 60 hours, fogginess or 4 or more symptoms post injury
Drugs for osteoporosis
Prolia (in renal dysfunction GFR >35) or bisphosphonates (cant do more than 5 years due to inc risk of atypical fractures)
Sesamoid Fracture
usually great toe. Blow, trauma, inc physical exercise.
Incidental Adenoma work-up
Rule out MACS (small secretion of cortisol) with dexa suppression test
Primary hyperaldosteronism
- Hypertension, hypernatremia, hypokalemia
- Dx: CT Abd, elevated Ald/renin
- Treat: U/l adenoma (Sx or aldosterone antag- spironolactone, epleronone) and b/l (aldosterone antagonist or potassium sparing (triamterene, amiloride)
Delirium tremens
Occurs 3-10 days post last drink. Even fever can occur.
Cocaine abuse
Can cause non-cardiogenic pulmonary edema.
Treatment of resistant heart failure
Vasodilators (Hydralazine, nitrates)
Tinea Capitis treatment
Oral griseofulvin or terbinafine
Metal FB in eye
Can cause rustic ring as it is toxic. Even if able to remove, refer to ophthal within 24-48h
Orthostatic hypotension
Drop in SBP 20 and DBP 10 within 3 minutes of standing up. HR changes by at least 30
Timed Up and go
10 seconds
Most common pregnancy complications in white woman
Obstetric and placental
What to do if a patient on DAPT needs surgery?
Should continue ASA but DC clopidogrel 5 days before
Carbapezapine side effect
Agranulocytosis
AAP recommendation regarding screening for hyperlidemia
Start in 9-11 years
Herald Patch, Christmas tree pattern
Oval, erythematous scaly lesions. Seen in Pityriasis roasea
Rockall scoring system for mortality in GIB patients
- Age >60, SBP <100, HR >100, signs of shock and co-morbidities
Rotavirus vaccine age specifications
Cant start post 15 weeks and dont continue past 8 months
Mallet Fracture
Blow to tip of finger causing distal phalanx fracture. Needs to be in extension splint for 8 weeks if <30% joint space involvement, otherwise need surgery
Hypoactive sexual desire disorder
No issues but just lack of sexual interest. In menstruating women, topical testosterone works.
Internal and external hemorrhoid management
- Internal: Banding or infra-red coag
- External: Elliptical incision if thrombosed and conservative if not.
Myelodysplastic syndrome
Causes megaloblastic anemia, thrombocytopenia and leukopenia. Before formation to leukemia
Stages of Asthma
- Intermittent (rule of 2): <2 days/wk, <2 nights/month, <2 days SABA/week. Normal FEV1 and ratio normal
- Mild persistent (rule of 2): >2d/w, up to 4n/mo, >2x SABA/week. FEV >80
- Mod persistent: Daily day symptoms and SABA use, x1n/week. FEV1 <80. Ratio reduced by 5
- Severe persistent: Daily, nightly, SABA mutliple times a day. FEV1 <60 and ratio reduced >5
SSRI you CANNOT use in pregnant
Paroxitine
Zoster Oticus
- Painful vesicles around palate and ears. Called Ramsay hunt syndrome if facial nerve involved.
- Careful to differentiate from herpes which only causes lesions in mouth
Occupational resp issues
-Asbestosis
- Silica
- Berrylium
- Asbestos: Ships, rail workers, boilermakers
- Silica: Sandblasters
- Berrylium: Mining and manufacturing
What happens to HR with age?
Resting and exercising HR decreases with age
Which medications are contraindicated in patients with cirrhosis?
NSAIDs.. As it can precipitate hepatorenal syndrome.
Erythrasma
- Erythematous and itchy patch
- Caused by cornybacterium
- Coral red on woods lamp
- Treat with topical erythromycin
GBS PPx in pregnancy in penicillin allergic patient
Cefazolin and Vanc/Clinda if higher concern for anaphylaxis.
Hoarseness
If persists >3 months, should be evaluated with laryngoscopy
Kidney stones
- Calcium oxalate, uric acid, cysteine form in acidic urine
- Struvite and calcium phos form in alkaline urine
Acne
- Non-inflammatory acne (comedones)- Treat with topical retinoids.
- Inflammatory (papules, pustules)- Mild/Mod (topical Abx but with BP) and severe (oral Abx).
- Resistant- Oral Tret
Most SPECIFIC sign of SCFE
internal rotation of the hip, especially when hip is flexed 90 degrees
Hypersensitivity pneumonitis
SOB, cough, chills appears within 4-6 weeks of exposure like mold. Usually resolves on own and get rid of offending agent.
Most common metabolic abnormality in CKD
Hyperparathyroidism. Ca and Phos levels are monitored every 3-6 months. alk phos every 6-12 months.
How to treat cough of normal cold?
Inhaled ipratropium is the ONLY recommended medicine.
Jaundice in newborns
- Breast milk Jaundice: Peaks around 2 weeks. Good weight gain.
- Breastfeeding Jaundice: When less breast milk is given. Low weight.
- Physiologic: appears <4 days.
- ABO hemolytic Jaundice: Mother has O pos blood and baby has A, B, A/B
Fluoride in children
- Supplement >6 months
- Deficiency appears with opaque, flecks in a lacy pattern or mottling.
Switching from dabigatran to warfarin
Start warfarin 3 days before stopping dabigatran.
Incision to drain a felon
High lateral
DRESS syndrome (Drug related eosinophilia and systemic symptoms)
- 1/3 cases are by ant-epileptics and highest mortality is with Allopurinol
- Presents with erythroderma, fever, LNpathy, eosinophilia and elevated liver enzymes
- Tx: Stop drug and start steroids.
Marfan syndrome
- Echo if family history even if asymptomatic. If symptomatic then 2 or more of features. Need echo every 6 months. Treat with BB
Most common stress fracture
Tibial
False positives of drug abuse
poppy seed, selegine, NSAID, dextromethorphan, venlafaxine, rifampin, vicks
Hyperthyroidism in pregnancy
PTU in first trimester and then methimazole
Fat pad Atrophy
Common cause of heel pain geriatric patients. Get worse as the day goes by
Worst withdrawal in which SSRI?
Venlafaxine. Abrupt withdrawal with confusion, agitation, seizures.
Incontinence MOA
- Stress incontinence (Sphincter problem)
- Urge (Detruser instability)
- Overflow (detruser hypotonia)
Melanoma diagnosis and treatment
- Diagnose with elliptical excision
- Treat with MOHS
Best treatment for SVT if no underlying heart conditions
Adenosine push
Chlamydia
Should be screened and treated as it can lead to infertility in the future.
Treat partners in the last 60 days .
Avoid sex for 7 days after treatment.
Does need test of cure.
Morning sickness in pregnancy
If more than 9 weeks then need to look for a different cause.
Most common cause of seizures in old people
Stroke
Age related macular degeneration risk factors
Hypertension and smoking
Abnormal pap test- Most dangerous lesion
Atypical glandular cells not other specified. precancerous.
Granuloma Annulare
Looks like ring worm. May not respond to anti-fungal, can use topical steroids but usually self limiting.
When is surgery indicated in Dupytrens Contracture?
If MCP is more than 30 degrees or PIP joint of any degree
How often do we need to repeat cologuard?
Every 3 years
Most common causes of cough in adults and children
- Adults: Upper airway cough syndrome, Asthma, Eosinophilic bronchitis and GERD
- Kids: UACS, bacterial bronchitis and asthma
Appropriate treatment of acute rhinosinusitis (No Abx)
Intranasal steroids.
ADHD treatment
Meds only after 6 years. 5-6 years should be treated with behavioral therapy
Excess of which vitamin is associated with hypercalcemia
Vitamin A
Test of diagnosis for Cushing’s Syndrome
Urinary cortisol, dex suppresion test
Penis lesions
- Pearly penile lesions: Small skin colored dome lesions around sulcus glans
- Lichen Nitidus: Hypopigmented lesions
- Lichen Sclerosis: Hypopigmented lesions that itch and bleed. May predispose to Ca.
- Ca: Beefy red lesions
- Angiokeratomas: Reddish-bluish papules around penis and scrotum
Treatment of chronic tension type headache
Amitryptiline. Reduces duration and frequency
When should you get MRI of breasts
Women at very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history.
Leser Trelat sign
Sudden onset of SK can indicate malignancy especially stomach adenocarcinoma
Which is the most common reason for hirsutism?
PCOS
Preoperative management of Warfarin
- High risk patients (TIA/Stroke/DVT/Heart valve within last 3 months or stenting within last 6 months) would need bridging therapy
- Low risk can have warfarin stopped 5 days prior and restart 1-2 days later
What is the common etiology of acute bronchitis
99% of cases are viral adn 1% is others
WPW syndrome treatment
Catheter ablation
Treatment of pulmonary hypertension secondary to COPD
Supplemental oxygen. Treatments of pulmonary arterial hypertension should not be used and can cause V/Q mismatch
Which antihypertensive can help with OSA
OSA can lead to resistant HTN. Spironolactone can reduce pharyngeal edema.
Fetal Alcohol syndrome
Curvature of the fifth finger of hands or flexion deformity of fingers
Which is an absolute contraindication of fibrinolytic therapy?
Ischemic stroke within last 3 months with patients with STEMI unless present within 4.5 hours.
Lymphadenopathy in patients
Older patients with chronic Lpathy shoulder undergo biopsy evaluation.
Post bariatric surgery monitoring
- DEXA every 2 years
- CBC, BMP, Vitamin D and B12
- Wait 12-18 months to get pregnant
- No fluids before and after meals
Functional ovarian cyst
Usually go away and repeat in 8-12 weeks.
>10 cm or symptomatic then can consider removal
CA-125 only for post menopausal
Who should be treated for asymptomatic bacteruria
Pregnant, before prostate or urological procedure
When should we start checking BP in kids?
3 years
Precocious puberty in boys age
<9
Lupus treatment
Mild: Hydroxychloroquine (dec arthritic pain)
Moderate, lupus nephritis: Azathioprine, cyclosporine
Severe and refractory: Rituximab, Mycophenalate
Low and high BNP
Low: Obese
High: elevated creatinine or low albumin
Anticoagulation decision with elderly
Use CHADsVASc. If concern for bleeding especially if >65 then use HAS-BLED.
Factors that predict if cardioversion will be successful in an A.fib patient
LA size (the larger, the worse outcome), underlying heart disease (RHD) and time patient has been in A.fib.
How to evaluate for scoliosis
Bent over test- 90 degrees parallel to the floor and use a scoliometer
Can get xrays and use the cobb angle (usually more than 20 degress)
AAP screening
-Dyslipidemia
- Depression
- IDA
Dyslipidemia 9-11
Depression 11-21
IDA 1
Plaque Psoriasis treatment
Topical steroids. If still have symptoms can ADD calcipotriene or tazarotene
Nutrition in severe pancreatitis
Enteral is preferred. Helps maintain gut barrier.
Chronic paroxysmal hemicrania
Like cluster headaches. But occur in women multiple times a day. Responsive to indomethacin
Treating Insomnia
Melatonin, doxepin then Lunesta (Eszopiclone) which has longer half life or zaleplon
Carotid artery stenosis
Asymptomatic would need Statin and yearly USG.
>70% would need intervention
Solar Lentigines
Liver spots. Need biopsy if bleeds, itches, painful or rapidly grow. Can be treated with cryotherapy, topical retinoids.
Topamax side effect
Can cause metabolic acidosis and lead to hypercalciuria and leads to stone formation
Factors that predict severity of pancreatitis
Cr, BUN, hematocrit
Stress cardiomyopathy management
Treat with BB, ACE I and diuretic. Dont need a statin.
Alcohol use disorder in early remission
Should have not had a drink for at least 3 months but less than 12
Cobb angle more than what needs surgical referral/bracing
> 25 will need bracing and monitoring
40 would need surgery
Treatment of anti-depressant induced sexual dysfunction
Wellbutrin
Blepharitis
Inflammation of eyelids and can present with some crusting. Treatment with warm compress and mild shampoo. Moderate with topical Abx and severe with oral Abx.
Is EKG needed for pre-op?
Only for high risk surgeries or if patients have cardiac history no matter the age
Biggest risk factors for esophageal cancer
Obesity or GERD
Aricept side effect
Can cause bradycardia and part of beer’s criteria
First line anti-hypertensive in pregnancy
Oral labatolol. Not Nifedipine as it can cause hypotension.
Anti-depressant which can be used in hospice and has shortest time to act
Ritalin (psychostimulant). Takes couple days to act.
ICU related delirum treatment
Atypical Antipsychotics (Zyprexa, seroquel)
Lithium side effects
Li- Leucocytes increase (leucocytosis)
Th- Thyroid
IU- Inc urination (DI)
M- Maformation (Ebstein)
Pustular Rosacea treatment
Doxycyline
ACS Abx
Always cover for Atypicals with Azitho
Factors associated with recurrence of BCC
- Mask areas, hand/feet/genetalia
- > 2cm and more than 0.6 cm in HR areas
When is extracoporal shock therapy useful?
Rotator cuff calcific tendinitis
Common side effect of Aromatase inhibitors
Like Letrozole.
Causes myalgias
What type of anemia is common with Mylodysplastic syndrome?
Macrocytic Anemia
Which head bleed needs immediate neurosurgical ref?
Cerebellar.
INR >1.5 needs reversal
Bipolar depression treatment
Lithium or depakote
CDC recs regarding travelling to TB endemic areas
Obtain a skin test prior to leaving and then get another 8-10 weeks after
Adrenarche
Usually if that is before sexual characteristics have developed then is idiopathic
What is severity of Anorexia based on?
BMI
Waldenstrom Microalbuminuria
+Bens Jones proteins
Which childhood condition is most effective with intense BT
Autism and should be started before 3.
Statins
Moderate: Simvastatin 20-40, Lipitor 10-20
High: Lipitor 40-80, Crestor 20-40
Infantile hemangioma
gone by 5 mo. steroid injection
