AAFP questions - first 68 sets Flashcards
Patient with no hx of smoking or occupational exposure - now has FEV1/FVCratio of 0.67. CXR shows pan-lobular emphysema. What condition is she likely to have?
α1-Antitrypsin deficiency
Other options: left heart failure, interstitial lung disease, bronchiectasis, and diffuse panbronchiolitis; are not associated with development of COPD or these CXR findings.
CXR findings of each of the following conditions
LHF
ILD
Bronchiectasis
Diffuse panbrnchioltiis
Left heart: pulmonary edema
Bronchiectasis: bronchial dilation and bronchial wall thickening
Interstitial lung disease: reticular/increased interstitial markings.
Diffuse panbronchiolitis: diffuse small centrilobular nodular opacities along with
hyperinflation.
What are pharmacologic treatments for BPH with LUTS?
- α-adrenergic blocker (doxazosin)
- 5-α-reductase inhibitor eg: finasteride (if there is evidence of prostatic enlargement via physical exam or a PSA level >1.5 ng/mL)
- phosphodiesterase-5 inhibitor (eg: tadalafil)
- antimuscarinic therapy (eg: tamsulosin)
57yo male presents with fatigue, erectile dysfunction and low libido. testosterone level is low. Next step?
Check FSH or LH level to rule out primary or secondary hypogonadism. (if low or normal = secondary)
dont forget:
LH acts on the interstitial Leydig cells of the testes, stimulating them to produce testosterone, whereas FSH stimulates spermatogenesis and Sertoli cell function
Treatment for functional constipation?
Polyethylene glycol
Functional constipation is hard, infrequent stools usually occurs in children and adolescents.
Daily use of polyethylene glycol (PEG) solution has been found to be more effective than lactulose, senna, or magnesium hydroxide in head-to-head studies. Evidence does not support the use of fiber supplements in the treatment of functional constipation.
A 2yo child is holding her left arm slightly pronated, flexed, and close to her body. No reported mechanism of injury. No sign of fracture (no erythema swelling bruiding) or abuse. Next step?
Attempted reduction of the subluxed radial head
Radial head subluxation, or nursemaid’s elbow, is the most common orthopedic condition of the elbow in
children 1–4 years of age, although it can be encountered outside of these ages as well.
The classic history includes a caregiver picking up (or pulling) a toddler by the arm. In half of all cases, however, no inciting event is
recalled.
Mariam you chose XRay but no need for XRay as long as there are no outward signs of fracture or abuse)
A patient who uses intravenous drugs and has a fever without a clear source must be evaluated for
……
infectious endocarditis (IE)
IE is usually right sided and tricuspid valve in IV drug users. Right sided endocarditis does not normally show systemic signs like janeway lesions or roth spots.
Order STAT blood cx and TTE
first-line therapy for primary dysmenorrhea
NSAIDs
should be started
at the onset of menses and continued for the first 1–2 days of the menstrual cycle.
combined OCP: lack of high quality randomized control trials demonstrating pain improvement
Jerking movements first in one hand and then the other, but when the patient is distracted the symptom resolves. What type of tremor is it?
- ANSWER: Psychogenic tremor: characterized by an abrupt onset, spontaneous remission, changing characteristics, and extinction with distraction.
- Cerebellar tremor: intention tremor with ipsilateral involvement. Neurologic testing will reveal past-pointing on finger-to-nose testing. CT or MRI of the head is the diagnostic test of choice.
- Parkinsonian tremor is noted at rest, is asymmetric, and decreases with voluntary movement. Bradykinesia, rigidity, and postural instability are generally noted.
- Essential tremor have symmetric, fine tremors that may involve the hands, wrists, head,
voice, or lower extremities. This may improve with ingestion of small amounts of alcohol.No
specific diagnostic test but treated with propranolol or primidone. - Enhanced physiologic tremor is a postural tremor of low amplitude exacerbated by medication. There is usually a history of caffeine use or anxiety.
Based on CDC guidelines; what induration in 48-72 hours is considered a positive screening test for TB in:
1- Patient with recent exposure, HIV, immunosuppresed: (a)_____ mm
2- For other individuals at increased risk for TB: (b)____mm
3- No known risks for TB infection: > (c) ____ mm
(a) 5
(b) 10
(c) 15
If positive; do a CXR and physcial exam to assess for active infection. If negative»_space; latent infection»_space; tx with isoniazid for 9 months in children, can reduce to 6 months in adults. Can also use combo of rifampin and isoniazid in adults only.
Which of the rotator cuff tendons is responsible for internal rotation?
Subscapularis (goes frominside the scapula, through the joint to the inside of the humerus)
Physical exam to test this:
pushing toward the midline against resistance while the shoulder is adducted and the elbow is bent to 90°. With the elbow still at 90° she is unable to keep her left hand away from her body when you position her hand behind her back.
infraspinatus and teres minor: external rotate
supraspinatus and deltoid: abduction
Acute abdominal pain in children- suspicion for appendicitis. First imaging modality?
Ultrasound
Iavoids radiation exposure and is useful for detecting many causes of abdominal pain, including appendicitis. After ultrasonography, CT or MRI can be used if necessary to diagnose appendicitis.
Abdominal radiography is helpful in patients with constipation, possible bowel obstruction, or a history of previous abdominal surgery.
The U.S. Preventive Services Task Force recommends depression screening for all adolescents ___ to ___ years of age.
12-18
Which GLP-1 agonist is shown to lower the risk of recurrent cardiovascular events and has received FDA approval for this indication?
Liraglutide (victoza)
This does NOT go for dulaglutide (trulicity) and semaglutide (ozempic)
What should sickle cell patients be screened for and with what?
risk of stroke with transcranial Doppler ultrasonography. assesses velocity of blood flow through the BVs
Results:
normal flow: 170cm/s»_space; repeat in one year
greater than 200cm/s»_space; repeat in one week to confirm, if high again, patient may need blood transfusion to reduce viscosity
anything in between: repeat in 6 weeks - 3 months
A chest radiograph, abdominal ultrasonography, a DXA scan, and renal Doppler ultrasonography are not recommended for screening patients with sickle cell disease.
In a newborn, other than a thin upper lip and a flat philtrum - what is the other big sign of Fetal alcohol syndorme?
Curvature of the fifth digit of the hand (clinodactyly)
Plagiocephaly, supernumerary digits, syndactyly, and metatarsus adductus are common in newborns but are not related to fetal alcohol spectrum disorders.
This child has otitis media with effusion, and the recommended course of action is __________
follow up in 3 months.
Medications, including decongestants, antihistamines, antibiotics, and corticosteroids, are not recommended.
Family physicians should be aware of the environmental exposures associated with pulmonary disease.
Stone cutting, sand blasting, mining, and quarrying expose patients to ___(a)___, which is an inorganic dust that causes pulmonary fibrosis.
Occupational exposure to ___(b)___, which is also an inorganic dust, occurs in the high-tech electronics manufacturing industry and results in chronic lung disease.
Exposure to ____(c)___ can result in “farmer’s lung,” a hypersensitivity pneumonitis.
(a) silica
(b) berylium
(c) organic agricultural dusts (fungal spores, vegetable products, insect fragments, animal dander, animal feces, microorganisms, and pollens)
Exposures to grain dust in bakers, can lead to asthma, chronic bronchitis, and COPD.
Firefighters are at risk of smoke inhalation and are exposed to toxic chemicals that can cause many acute and chronic respiratory symptoms.
Initial feeding /drinking recs for someone with acute gastroenteritis?
Half-strength apple juice and food on demand
Half-strength apple juice has been shown to be effective, and it approximates an oral rehydration solution. Its use prevents the purchase of beverages with an inappropriate osmolarity. Low osmolarity solutions contain glucose and water, which decrease stool frequency, emesis, and the need for intravenous fluids compared to higher osmolarity solutions like soda and most sports drinks. Water increases the risk of hyponatremia in children. Early refeeding has been shown to decrease the duration of illness.
β-Blockers are the initial therapy for patients with symptomatic hypertrophic cardiomyopathy.
The dietary herbal supplement with the highest risk for drug interactions is
St. John’s wort
It can reduce the effectiveness of multiple medications because it is an inducer of CYP3A4 and P-glycoprotein synthesis. Concurrent use of St. John’s wort with drugs that are metabolized with these systems should be avoided. These include cyclosporine, warfarin, theophylline, and oral contraceptives. St. John’s wort should be avoided in patients taking either over-the-counter or prescription medications.
A Wood’s lamp may assist with the diagnosis of certain skin conditions. What color is revealed with the following conditions?
Erythrasma (Corynebacterium minutissimum): (a)
Pseudomonas: (b)
Tinea infections: (c)
Vitiligo: (d)
(a) coral pink
(b) pale blue
(c) yellow
(d) totally white
A 69-year-old female presents with scaling, redness, and irritation under her breasts for the past several months. She has tried several over-the-counter antifungal creams without any improvement. Next step?
Wood lamps to check for erythrasma (coral pink)
Erythrasma is a common, chronic superficial bacterial infection of the skin (caused by Corynebacterium minutissimum). Often confused with intertrigo because of lboth occur in similar locations (creases).
Visual: plaques sharply demarcated, minimally red, subtle, symmetrical. Intertrigo is more inflammatory, more erythema and serous discharge.
Both can occur together.
Treatment of erythasma?
washing with antibacterial soap, topical 2% clindamycin or 10-20% aluminum chloride
OR oral erythromycin x 5 days