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UWorld > AAFP_questions > Flashcards

AAFP_questions Flashcards

1
Q

Medications that adversely affect bone density:

A

phenytoin, glucocorticoids, phenobarbital, heparin

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2
Q

Is CK elevated in polymyalgia rheumatica?

A

no

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3
Q

What is the recommended vit D supplementation?

A

9-50: 200 units
51-70: 400 units
71 - : 600 units

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4
Q

Patients who are beginning long-term treatment with prednisone (≥3 months at a dosage ≥5 mg/day), or an equivalent, receive

A

bisphosphonate therapy in addition to calcium and vitamin D supplementation

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5
Q

What are the Ottawa ankle rules?

A

ankle radiographs should be done if

1) the patient has pain at the medial or lateral malleolus
2) bone tenderness at the back edge or tip of the lateral or medial malleolus
3) inability to bear weight immediately after the injury or in the emergency department

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6
Q

What is the differential when the FABER test (flexion, abduction, external rotation) elicits pain ANTERIORLY vs POSTERIORLY?

A 
posteriorly = sacroiliac involvement, contralateral
anteriorly = hip; ipsilateral
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7
Q

Name a pain med patients with a history of seizure shouldn’t take?

A

tramadol

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8
Q

What is the only approved treatment for male osteoperosis?

A

alendronate; PTH

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9
Q

When does the extrusion reflex disappear/babies can start taking food?

A

4 months

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10
Q

If you suspect a guy has hypogonadism, what is the appropriate test?

A

total testosterone (only order free testosterone if the total is off)

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11
Q

What is the first step phenomenon?

A

plantar fasciitis worse in the morning or after sitting for a long time

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12
Q

Numbness and paresthesia over the anterolateral thigh with no motor dysfunction:

A

Meralgia paresthetica, or lateral femoral cutaneous neuropathy (may be 2/2 diabetes)

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13
Q

Valsalva increases (preload/afterload) and causes which murmurs to get louder?

A

Valsalva increases preload.

HCM murmur gets louder; MVP gets louder and longer

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14
Q

Drugs that decrease conduction through the AV node:

A

adenosine, digoxin, CCBs. Do not use in WPW!

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15
Q

What do you do to decrease tachy in WPW?

A

procainamide…possibly amiodarone

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16
Q

Before infliximab use, screen for

A

TB, Hep B, Hep C

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17
Q

What test do you use to initially assay for HCV?

A

enzyme immunoessay. Then do confirmatory immunoblot. Finally HCV RNA PCR

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18
Q

Before infliximab use, screen for

A

TB, Hep B, Hep C

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19
Q

What test do you use to initially assay for HCV?

A

enzyme immunoessay. Then do confirmatory immunoblot. Finally HCV RNA PCR

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20
Q

Gait apraxia that is described as “magnetic,” with start and turn hesitation and freezing:

A

frontal lobe degeneration

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21
Q

“Steppage” gait resulting from foot drop with excessive flexion of the hips and knees when walking, short strides, a slapping quality, and frequent tripping:

A

motor neuropathy

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22
Q

(1) uniform, symmetric digit swelling; (2) at rest, digit is held in partial flexion; (3) excessive tenderness along the entire course of the flexor tendon sheath; and (4) pain along the tendon sheath with passive digit extension

A

pyogenic tenosynovitis

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23
Q

What is scombroid poisoning?

A

After eating tuna or mackerel! Happens in minutes to hours: paresthesias, pruritus, urticaria, nausea…treat like allergic reactions/anaphylaxis

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24
Q

Why does tinea capitis require systemic abx?

A

to reach the hair shafts

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25
Q

Why can omeprazole be associated with osteopenia?

A

decreases calcium (and B12) absorption

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26
Q

Why does tinea capitis require systemic abx?

A

to reach the hair shafts

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27
Q

What are the only medications that have been confirmed to prevent hip AND vertebral fracture?

A

zolendronic acid, risedronate, and alendronate

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28
Q

Erythrasma is caused by Corynebacterium minutissimum and is treated by

A

topical or oral erythromicin

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29
Q

How do you diagnose diabetes?

A

1) hemoglobin A1c level ≥6.5%
2) fasting plasma glucose level ≥126 mg/dL
3) a random glucose level ≥200 mg/dL in a patient with symptoms of diabetes
4) 2-hour oral glucose tolerance test value ≥200 mg/dL.

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30
Q

Who should be screened for osteoperosis?

A

all women over 65 (those with risk factors from 60-64); all men over 70

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31
Q

Patient who had been in Middle East with papule on his forearm that subsequently ulcerates to form a shallow annular lesion with a raised margin. Lesion shows no signs of healing 3 months after it first appeared

A

Leishmoniasis

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32
Q

What is the preferred abx regimen for pertussis?

A

azithromycin for 3–5 days or clarithromycin for 7 days. Or Bactrim. **Do not use erythromicin in children under 1 month due to risk of pyloric stenosis

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33
Q

What is the preferred abx regimen for pertussis?

A

azithromycin for 3–5 days or clarithromycin for 7 days. **Do not use erythromicin in children under 1 month due to risk of pyloric stenosis

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34
Q

Which SSRI is associated with the most weight gain? Which with the least?

A

most = paroxetine. Least = fluoxetine.

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35
Q

Which SSRI is associated with the most weight gain? Which with the least?

A

most = paroxetine. Least = fluoxetine.

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36
Q

Herpangina occurs in the (anterior/posterior) pharynx, while HSV gingivostomatitis occurs in the (anterior/posterior) pharynx

A

Herpangina: posterior
HSV: anterior

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37
Q

How do you treat rosacea?

A

Oral metronidazole, doxycycline, or tetracycline (esp if ocular symptoms)

Clonidine or non-selective BB for flushing

Avoidance of precipitants

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38
Q

What is a benefit of using in vitro interferon-gamma release assays?

A

M. tuberculosis specific proteins (won’t be found in BCG vaccine)

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39
Q

What is the most common cause of diarrhea in adults?

A

Norwalk virus

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40
Q

What is a positive tuberculin skin test?

A

1) highest risk and/or immunocompromised, including HIV-positive patients, transplant patients, and household contacts of a tuberculosis patient, an induration ≥5 mm
2) children; employees or residents of nursing homes, correctional facilities, or homeless shelters; recent immigrants; intravenous drug users; hospital workers; and those with chronic illnesses > 10mm (or >10 mm change w/in 2 years)
3) lowest risk >15mm

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41
Q

Hypertension and hyperreflexia, sweating after taking dextromethorpan:

A

serotonin syndrome

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42
Q

How is glycopyrrolate similar/different to/from atropine, hyoscyamine, and transdermal scopolamine?

A

They are all used to reduce resp secretins.
But glycopyrrolate does not cross the blood-brain barrier, and is therefore least likely to cause central nervous system effects such as sedation.

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43
Q

How is glycopyrrolate similar/different to/from atropine, hyoscyamine, and transdermal scopolamine?

A

They are all used to reduce resp secretins.
But glycopyrrolate does not cross the blood-brain barrier, and is therefore least likely to cause central nervous system effects such as sedation.

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44
Q

When do you screen for diabetes?

A

Adults with BMI > 25 and adults every 3 years starting with age 45

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45
Q

Children should sit rear-facing in car seat until

A

Until the child is at least 12 months old AND weighs at least 20 lb

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46
Q

Children should sit rear-facing in car seat until

A

Until the child is at least 12 months old AND weighs at least 20 lb

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47
Q

What is the major and minor criteria for acute rheumatic fever?

A 
Major: JONES
migratory arthritis
carditis
nodules (subcutaneous)
erythema marginatum Syndenham's chorea

MINOR:
fever, arthralgia, an elevated erythrocyte sedimentation rate or C-reactive protein (CRP) level, and a prolonged pulse rate interval on EKG

Two major criteria, or one major criterion and two minor criteria, plus evidence of a preceding streptococcal infection, indicate a high probability of the disease

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48
Q

What are the goals of treatment for gestational diabetes?

A

fasting plasma glucose levels below 95 mg/dL and 1-hour postprandial levels below 140 mg/dL

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49
Q

Suspect PCV if

A
  • -Hgb >16, WBC > 12, plts > 400
  • -splenomegaly
  • -PVT
  • -elevated leukocyte alkaline phosphatase, elevated B12
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50
Q

Treatments for lice?

A

malathion (most effective), permethrin, pyrethrins (lindane no longer effective)

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51
Q

Causes of QT prolongation?

A

1) congenital
2) hypomagnesemia, hypokalemia, hypocalcemia
3) antipsychotics, TCAs, antihistamines, citalopram, macrolides, class Ia,b and III antiarrythmics

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52
Q

Causes of QT prolongation?

A

1) congenital
2) hypomagnesemia, hypokalemia, hypocalcemia
3) antipsychotics, TCAs, antihistamines, citalopram, macrolides, class Ia,b and III antiarrythmics

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53
Q

Which finger is most commonly affected in Dupuytren’s?

A

fourth finger

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54
Q

Possible adverse effects of cholinesterase inhibitors (eg donepezil)?

A

bradycardia and syncope

tacrine is associated with hepatic dysfunction

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55
Q

Possible adverse effects of cholinesterase inhibitors (eg donepezil)?

A

bradycardia and syncope

tacrine is associated with hepatic dysfunction

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56
Q

Diffuse melanin pigmentation is an oral finding of

A

Addison’s disease

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57
Q

Diffuse melanin pigmentation is an oral finding of

A

Addison’s disease

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58
Q

How does finasteride affect PSA levels?

A

Falsely depresses them

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59
Q

How does finasteride affect PSA levels?

A

Falsely depresses them

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60
Q

What is the treatment for SYMPTOMATIC multiple myeloma?

A

autologous stem cell transplant; those who cannot undergo transplant receive melphalan and prednisolone with or without thalidomide

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61
Q

What is the treatment for epididymitis?

A

ages 14-35: 250mg ceftriaxone and 1g azithro (or 100mg BID doxy x 10d)
35: levofloxacin

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62
Q

Elevated alkaline phosphatase with elevated 5’-nucleotidase indicates

A

liver pathology

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63
Q

Elevated alkaline phosphatase with elevated 5’-nucleotidase indicates

A

liver pathology

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64
Q

Where are ST changes seen from

1) circumflex occlusion?
2) LAD occlusion?
3) RCA occlusion?

A

circumflex: I, aVL, V5 and V6
LAD: V1-V6
RCA: II, III, aVF

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65
Q

“Baby blues” should resolve within __ days of birth

A

10

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66
Q

What is first-line treatment for PPD in breastfeeding women?

A

sertraline

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67
Q

What is telogen effluvium? Vs anagen effluvium?

A

Shedding hair loss occurring after a stressful event when large numbers of anagen hairs (usually 90% of hairs) are triggered to telogen (10% normally). This hair loss lasts 6 months after removal of the stressful trigger.

Anagen effluvium: hair loss that occurs with ctx

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68
Q

What is the most efficacious medicatoin for allergic rhinitis?

A

topical intranasal glucocorticoids

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69
Q

What is rhinitis medicamentosa?

A

rebound nasal congestion brought on by extended use of topical decongestants (oxymetazoline, phenylephrine, naphazoline, zylometazoline). DO NOT USE THESE MORE THAN 3 DAYS

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70
Q

In the acute phase, which serum protein levels elevate?

Which decrease?

A

elevation: ceruloplasmin, complement, haptoglobin, fibrinogen, CRP
decrease: albumin, transferrin

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71
Q

What do you measure to assess vit D status?

A

25-hydroxyvitamin D

if <20, vit D deficiency

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72
Q

Long QT is >___ msec

A

> 460 in females, > 440 in males

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73
Q

Which atypical antipsychotic is associated with the least weight gain?

A

aripiprazole

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74
Q

Which atypical antipsychotic is associated with the least weight gain?

A

aripiprazole

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75
Q

The diagnosis of multiple myeloma is confirmed by:

A

bone marrow showing >10% plasma cells

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76
Q

Patients who develop spontaneous PTX (<15% of lung volume) can be managed how?

A

analgesics and follow-up within 72 hours

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77
Q

In stroke patients, high BP is tolerated to SBP ___ mm Hg and DBP ___ mm Hg

A

SBP < 220; DBP <120. Cautiously only bring down by 10-15% by monitoring neurologic status

78
Q

In setting of pancreatitis, a threefold or greater elevation of ALT has a PPV of 95% for

A

gallstone pancreatitis

79
Q

Development of a sterile pustule with an erythematous margin within 48 hours of aseptic needle prick…

A

Behcet’s syndrome! (recurrent genital nad oral ulceration and relapsing uveitis with progression to blindness potentially)

80
Q

Chorionic villus sampling can be offered at _____ weeks gestation

Amniocentesis: _______

A

CVS: 10-13 weeks
Amniocentesis: 16-18 weeks

81
Q

T/F: If patients are managed on a rhythm control strategy for afib (not recommended), they should be maintained on a/c regardless of whether they are consistently in sinus rhythm

A

true

82
Q

At what age should a more serious condition be worked up if there is no signs of puberty in boys or girls?

A

age 14 (no breast development in girls, no testicular enlargement in boys)

83
Q

Since this drug is the most common source of iodine excess in the US, it is not surprising that 10% of patients treated with it will develop hyperthyroidism:

A

amiodarone

84
Q

Anterior knee pain on climbing stairs/squatting/running; normal range of motion; lateral deviation of patella on extension (“J sign”)

A

patellofemoral stress syndrome. Treat with PT

85
Q

P450 inhibitors:

A

MAGIC RACKS in GQ

macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir, acute alcohol abuse, ciprofloxacin, ketoconazole, sulfonamides, gemfibrozil, quinidine

86
Q

Dupuytren’s disease is associated with which other disease?

When is surgery indicated?

A

diabetes mellitus. Surgery indicated when contracture reaches 30*

87
Q

WHat is carnett’s sign?

A

easing of pain of abdominal palpation with tightening of stomach muscles. If cause is visceral, should relieve pain vs intrabdominal hematoma, etc

88
Q

The most accurate way to gauge gestational age is ___ in the first trimester

After 11 weeks, _________ is the best way

A

<11 weeks = crown-rump length

then biparietal diameter

89
Q

The most accurate way to gauge gestational age is ___ in the first trimester

After 11 weeks, _________ is the best way

A

<11 weeks = crown-rump length

then biparietal diameter

90
Q

How many minutes of exercise is necessary to begin burning fat stores?

A

30 minutes (glycogen is the energy source for the first 20 minutes)

91
Q

What is the treatment of otitis media in kids?

A

amoxicillin 80-90 mg/kg/day

92
Q

Skin tags, or arochordons, are associated with

A

diabetes mellitus and obesity

93
Q

What are some first-line therapies for migraine ppx in adults?

A

propranolol, timolol, amitryptiline, divalproex sodium, sodium valproate, and topiramate; NSAIDS, CCBs

94
Q

Prominent, warm, papular, and serpiginous skin lesions…

A

urticaria!

95
Q

How can you distinguish quadriceps tendon rupture from patellar tendon rupture?

A

In both cases patient can’t straighten leg actively. But in patellar tendon rupture, patella is retracted superiorly
Quadriceps rupture produces “sulcus sign” = painful indentation just above the patella but it might not be felt if long time after injury and gap is filled with blood

96
Q

What is a reactive heart rate?

A

At least 2 accelerations within 20 minutes.

Accelerations are defined as 15 bpm above baselines for at least 15 seconds if beyond 32 weeks gestation, or 10 bpm for at least 10 seconds if at or below 32 weeks

97
Q

A simple scrotal hydrocele without communication with the peritoneal cavity and no associated hernia should be excised if it has not spontaneously resolved by the age of

A

12 months

98
Q

What is seen in tarsal tunnel syndrome?

A

paresthesias in the medial aspect of ankle and heel and sometimes plantar surface of foot with PRONATION

99
Q

Chronic orthrostatic hypotension can be treated by:

A

fludrocortisone, midodrine, and physostimine

100
Q

What is Osler-Weber-Rendu syndrome? All patients with possible or confirmed should have what screen?

A

Hereditary hemorrhagic telangiectasia (HHT).

Should be screened for pulmonary arteriovenous malformations with contrast echocardiography

101
Q

What are the results of the Weber test if the affected ear hears it better? Normal ear?

A

If affected ear hears Weber (forehead) better: conductive hearing loss

If normal ear hears it better: sensorineural

102
Q

Active viral replication can occur during the immune-tolerant phase of HBV with little or no evidence of disease activity. This can last for many years before progressing to immune-active phase, which is evidenced by

A

elevated liver enzymes (indicating liver inflammation) and the presence of HBeAg

103
Q

What is the inactive carrier phase of HBV characterized by?

A

clearance of HBeAg and development of anti-HBeAG and normalizatio nof liver enzymes; also reduced levels of HBV virus

104
Q

How do you treat persistent VF?

A

1) electrical defibrillation and CPR
2) vasopressor (epinephrine or vasopressin)
3) amiodarone if unresponsive to the above 2
4) lidocaine (only when amiodarone not available)
* *Mg can be used to prevent TdP in patients with prolonged Qt

105
Q

T/F: Up to 75% of patients with cough caused by GERD may have no GI symptoms

A

true

106
Q

Plaque psoriasis is a lifelong disease, unlike ______ psoriasis which may be self-limited and never recur

A

guttate

107
Q

Which foods worsen gout? Which improve it?

A

Worsen: red meat, seafood, and alcohol; nuts and beans
Improve: dairy products

108
Q

a red conjunctiva, a pale fundus, a cherry-red spot at the fovea, and “boxcarring” of the retinal vessels:

A

central retinal artery occlusion (also with amarousis fugax)

109
Q

What is a positive Thompson sign?

A

Absence of passive plantar foot flexion when the calf is squeezd = seen with Achilles tendon rupture

110
Q

What can be used for ppx abx for traveler’s diarrhea?

A

for immunocompromised/short trips = rifaximin

111
Q

Most hearing impairments in children are due to

A

genetic disorders = Waardenburg syndrome, Usher’s syndrome, Alport syndrome, Turner’s syndrome

112
Q

Why should patients receiving testosterone have Hct monitored q6m until 18m then annually?

A

T can cause polycythemia

113
Q

For whom is repeat colonoscopy in 3 years recommended?

A

1) high grade dysplasia
2) 3 or more adenomas
3) adenomas with villous features
4) adenoma > 1 cm in size

114
Q

What are signs of peripheral vertigo?

A

dizziness with

1) first arising
2) rolling over in bed
3) with nausea and vomiting

115
Q

What are signs of central vertigo?

A

Diplopia, weakness, difficulty with speech, etc

116
Q

What is ambylopia?

A

cortical visual impairment from abnormal eye development (often strabismus)

117
Q

What is esotropia, exotropia, and heterophoria?

A

esotropia: inward/nasal deviation of eye (corneal light reflex lateral to normal position)
exotropia: outward deviation of eye (corneal light reflex medial to normal position)
heterophoria: latent strabismus, does not cause eye deviation when both eyes are uncovered

118
Q

Hearing loss >__ months may indicate need for tympanostomy tubes.

A

> 3 months

119
Q

What are the warning signs for IBS?

A

rectal bleeding, anemia, weight loss, fever, FH of colon cancer, onset of sx after 50, and a major change in symptoms

120
Q

Locking of knee with extension of knee suggests:

A

loose body or meniscal tear

121
Q

What is a specific test for rheumatoid arthritis?

A

anti-CCP

122
Q

Imiquimod can only be used for treatment of external genital and perianal warts in patients ___ years of age and older

A

12

123
Q

Cow’s milk can be started in children __ months and older

A

12

124
Q

How do you diagnose Kawasaki?

A

fever for at least 5 days
at least four of the following symptoms must be present: 1) nonexudative conjunctivitis that spares the limbus;
2) changes in the oral membranes such as diffuse erythema, injected or fissured lips, or “strawberry tongue”;
3) erythema of palms and soles, and/or edema of the hands or feet followed by periungual desquamation;
4) cervical adenopathy in the anterior cervical triangle with at least one node larger than 1.5 cm in diameter; and,
5) an erythematous polymorphous rash, which may be targetoid or purpuric in 20% of cases

125
Q

What is Waldenstrom’s macroglobulinemia?

A

Uncontrolled proliferation of lymphocytes and plasma cells. Weakness, fatigue, weight loss, bleeding, and recurrent infections are common presenting symptoms.
Anemia, monoclonal IgM peaks, Bence Jones protein (tends to be absent in MGUS).
NO LYTIC bone lesions; and marrow bx shows mostly lymphocytes

126
Q

Persistent groin pain, limited hep flexion, limited internal rotation:

A

stress fractures of the femoral neck

127
Q

Thalamotomy and pallidotomy, contralateral to the side of hte body most affected, are the most effective tx for the unilateral tremor and dyskinesia from

A

Parkinson’s

128
Q

Which drugs might cause serotonin syndrome?

A

MAOIs, atypical antipsychotics, tramadol, meperidine, sumatriptan, lithium, St John’s wort, gingko biloba, sibutramine

129
Q

How do you diagnose preeclampsia?

A

SBP > 140, DBP >90, 300mg protein in 24 h urine

130
Q

When should phototherapy be initiated?

A

infants 29-48 hours: 15 mg/dL
49-72 hours: 18 mg/dL
>72 hours: 20 mg/dL

131
Q

Which fluorquinolone should not be used for UTIs?

A

moxifloxacin

132
Q

What is the most common cause of PNA in children age 4 months to 4 years?

A

RSV. Mid-winter or early spring!

133
Q

Which antidepressant is associated with withdrawal (agitation, anorexia, confusion, impaired coordination, seizures, sweating, vomiting) after abrupt discontinuation?

A

venlafaxine

134
Q

How is the pain from fat pad atrophy different from plantar fasciitis?

A

fat pad atrophy seen in geriatric patients; pain worse as day goes on

135
Q

What is mild intermittent asthma?

A

daytime sx no mroe than 2 days per week and nighttime sx no more than 2 nights per month. FEV1 80% or more of predicted

136
Q

What is mild persistent asthma?

A

daytime sx more than 2 days per week but less than daily; nighttime sx more than 2 nights per month. FEV1 80% or more of predicted

137
Q

What is moderate persistent asthma?

A

daytime sx daily and nighttime sx more than 1 night per week. FEV1 60-80% of predicted

138
Q

What is severe persistent asthma?

A

Continuous daytime sx and frequent nighttime sx. FEV1 <60% or less of predicted

139
Q

T/F: Calcitonin, intranasal or subcutaneous, provides pain relief in a few days in patients with osteoporotic vertebral compression fractures

A

True

140
Q

The greatest iron demand in pregnancy is in the (first/second) half

A

first

141
Q

What are some tocolytics?

A

magnesium sulfate, terbutaline, ritodrine (can all cause resp distress)
Indomethacin and nifedipine do not depress respiration

142
Q

Echinacea is used for

A

URI. but hasn’t been foudn to be very effective

143
Q

What is the management of patient’s with Marfan’s syndrome and echocardiographic evidence of aortic abnormalities?

A

placed on B-blockers and monitored with echocardiography every 6 months

144
Q

Which head and neck lymphadenopathy is most likely to be malignant?

A

supraclavicular

145
Q

If gest age is 12 weeks, ___ mcg

A

50mcg 12 weeks

146
Q

What is the most common complication of Roux-e-Y bypass?

A

iron and B12 deficiencies

147
Q

erythroderma accompanied by fever, lymphadenopathy, elevation of liver enzymes, and eosinophilia:

A

DRESS! Common offending meds are carbamazepine, phenytoin, lamotrigine, phenobarbital. Allopurinol-induced has highest mortality

148
Q

What is normal ABI?

A

0.9-1.2

149
Q

A new LBBB suggests occlusion of which artery?

A

LAD

150
Q

Which procedures are linked with the highest incidence of VTE events?

A

neurosurgical procedures (particularly with penetration of brain or meninges) and orthopedic surgeries (esp of hip)

151
Q

The most common rec for surgical repair of AAA is when it reaches ___ cm in diameter

A

5.5 cm

152
Q

As long as patients can do activity (greater than __ METS) without cardiac sx, no need for stress testing preoperatively

A

4

153
Q

Who needs a preoperative EKG?

A

males over 45, females over 55, patients with diabetes, sx of CP, or a previous hx of cardiac disease

154
Q

A BNP < ___ excludes CHF but >___ is 95% predictive

A

400 = likely CHF

Between 100-400 could be PE, pulm cancer, cor pulmonale

155
Q

T/F: Do not use cilostazol in CHF

A

true

156
Q

Which antihypertensives should we use in older populations?

A

thiazide, calcium channel blockers

157
Q

Peripheral vascular disease patients have what happen to them after exercise?

A

decrease in ABI; 20mm Hg or greater decrease in SBP

158
Q

What are the criteria for SEVERE preeclampsia?

A

1) BP 160/110 or higher, 6 hours apart
2) proteinuria >5g/24h
3) plt <100K
4) liver enzyme abnormalitties
5) epigastric or RUQ pain
6) AMS

159
Q

Red flags indicating possible thyroid cancer in a thyroid nodule:

A

male gender; age 65 years; rapid growth of the nodule; symptoms of local invasion such as dysphagia, neck pain, and hoarseness; a history of head or neck radiation; a family history of thyroid cancer; a hard, fixed nodule >4 cm; and cervical lymphadenopathy

160
Q

ACe-inhibitors should not be given to a patient with a history of

A

angioneurotic edema

161
Q

How can you distinguish Meckel’s diverticulum from appendicitis?

A

rectal bleeding in Meckel’s, but not appendicitis

162
Q

Which gastroenteritis causing organisms are resistant to chlorine?

A

Cryptosporidium oocysts and Giardia cysts

163
Q

Treatment of chronic paronchyia:

A

use of strong topical corticosteroids over several weeks can greatly reduce the inflammation, allowing the nail folds to return to normal and helping the cuticles recover their natural barrier to infection

164
Q

Persistent melasma can be treated with

A

hydroquinone cream, retinoic acid, and/or chemical peels

165
Q

Painful ingrown toenails that display granulation tissue and lateral nail fold hypertrophy should be treated with:

A

Excision of the lateral nail plate with lateral matricectomy

166
Q

Which meds for alcohol dependence have the most efficacy?

A

acamprosate, naltrexone

167
Q

A post-traumatic air-fluid level in the sphenoid sinus is associated with

A

basilar skull fractures

168
Q

Double vision, fluid in the maxillary sinus, an air-fluid level in the maxillary sinus, and diplopia is associated with:

A

orbital floor fractures

169
Q

Abduction of the thumb is a function of which nerve?

A

radial

170
Q

The ability to touch the tip of the thumb to the tip of the little finger is normal motor function of which nerve?

A

medial

171
Q

What is autonomic hyperreflexia?

A

sudden onset of headache and hypertension in a patient with a lesion above the T6 level. There may be associated bradycardia, sweating, dilated pupils, blurred vision, nasal stuffiness, flushing, or piloerection

Quadriplegic patients; bowel and bladder distention are common causes

172
Q

What are contraindications for TPA in stroke?

A

blood glucose levels 400 mg/dL, resolving transient ischemic attack, and hemorrhage visible on a CT scan. Time limit 3 hours

173
Q

Why shouldn’t meperidine be used in geriatric patients?

A

metabolite can accumulate and cause seizures

174
Q

Which parasomnias occur in the first half of the night? which the second?

A

first half = nREM sleep = sleepwalking, sleep terrors, confusional arousal

second half: nightmares

175
Q

Which antipsychotic should be used in Parkinson’s?

A

quetiapine (doesn’t affect D2 receptor)

176
Q

Which SSRI is least likely to inhibit cytochrome P450?

A

citalopram; use for multiple comorbidities

177
Q

How do progesterone levels predict fetal outcome?

A

> 25 = healthy pregnancy; <5 = nonviable

178
Q

What are the Amsel criteria?

A 
Must have 3 of 4:
pH >4.5 (most sensitive), 
clue cells >20% (most specific),
a homogeneous discharge,
and a positive whiff test (amine odor with addition of KOH)
179
Q

What is the most common symptom of vulvar cancer?

A

longstanding pruritus

180
Q

At 35-37 weeks gestation, cultures of GBS must be taken from where?

A

vaginal introitus and rectum (GI tract is the most likely reservoir of GBS)

181
Q

Colpitis macularis (strawberry cervix) is associated with which vaginal infection?

A

Trichomonal vaginitis

182
Q

What is the most common histologic diagnosis in patients evaluated for AGUS?

A

cervical intraepithelial neoplasia

183
Q

Metronidazole gel and clindamycin are useful for treating _______ but ineffective for _______

A

can treat BV but not trichomonas

184
Q

When is postterm pregnancy?

A

42 weeks! perinatal mortality doubles there

185
Q

Simple ovarian cysts that are less than __ cm in size, as long as they are asymptomatic, can be monitored with ultrasound in 2 months

A

<8 cm in size

186
Q

Miliary lesions in CXR think of

A

histoplasmosis, miliary TB

187
Q

The CXR of a child with meconium aspiration syndrome will show

A

patchy atelectasis or consolidation

188
Q

What will the CXR of a patient with transient tachypnea of the newborn show?

A

wet silhouette around the heart, diffuse parenchymal infiltrates, or intralobar fluid accumulation

189
Q

What will the CXR of a child wtih hyaline membrane disease show?

A

air bronchograms

190
Q

What are risk factors for transient tachypnea of the newborn?

A

C section, macrosomia, male gender, maternal asthma and or diabetes

191
Q

CAP should be treated with azithromicin unless…

A

treated within the previous 3 months with abx. Fluoroquinolone should then be used, or a B lactam and a macrolide!

192
Q

What is the most common presenting symptom of glaucoma?

A

tunnel vision

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