AAFP_questions Flashcards
(192 cards)
1
Q
Medications that adversely affect bone density:
A
phenytoin, glucocorticoids, phenobarbital, heparin
2
Q
Is CK elevated in polymyalgia rheumatica?
A
no
3
Q
What is the recommended vit D supplementation?
A
9-50: 200 units
51-70: 400 units
71 - : 600 units
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
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
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
7
Q
Name a pain med patients with a history of seizure shouldn’t take?
A
tramadol
8
Q
What is the only approved treatment for male osteoperosis?
A
alendronate; PTH
9
Q
When does the extrusion reflex disappear/babies can start taking food?
A
4 months
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)
11
Q
What is the first step phenomenon?
A
plantar fasciitis worse in the morning or after sitting for a long time
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)
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
14
Q
Drugs that decrease conduction through the AV node:
A
adenosine, digoxin, CCBs. Do not use in WPW!
15
Q
What do you do to decrease tachy in WPW?
A
procainamide…possibly amiodarone
16
Q
Before infliximab use, screen for
A
TB, Hep B, Hep C
17
Q
What test do you use to initially assay for HCV?
A
enzyme immunoessay. Then do confirmatory immunoblot. Finally HCV RNA PCR
18
Q
Before infliximab use, screen for
A
TB, Hep B, Hep C
19
Q
What test do you use to initially assay for HCV?
A
enzyme immunoessay. Then do confirmatory immunoblot. Finally HCV RNA PCR
20
Q
Gait apraxia that is described as “magnetic,” with start and turn hesitation and freezing:
A
frontal lobe degeneration
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
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
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
24
Q
Why does tinea capitis require systemic abx?
A
to reach the hair shafts
25
Why can omeprazole be associated with osteopenia?
decreases calcium (and B12) absorption
26
Why does tinea capitis require systemic abx?
to reach the hair shafts
27
What are the only medications that have been confirmed to prevent hip AND vertebral fracture?
zolendronic acid, risedronate, and alendronate
28
Erythrasma is caused by Corynebacterium minutissimum and is treated by
topical or oral erythromicin
29
How do you diagnose diabetes?
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.
30
Who should be screened for osteoperosis?
all women over 65 (those with risk factors from 60-64); all men over 70
31
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
Leishmoniasis
32
What is the preferred abx regimen for pertussis?
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
33
What is the preferred abx regimen for pertussis?
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
34
Which SSRI is associated with the most weight gain? Which with the least?
most = paroxetine. Least = fluoxetine.
35
Which SSRI is associated with the most weight gain? Which with the least?
most = paroxetine. Least = fluoxetine.
36
Herpangina occurs in the (anterior/posterior) pharynx, while HSV gingivostomatitis occurs in the (anterior/posterior) pharynx
Herpangina: posterior
HSV: anterior
37
How do you treat rosacea?
Oral metronidazole, doxycycline, or tetracycline (esp if ocular symptoms)
Clonidine or non-selective BB for flushing
Avoidance of precipitants
38
What is a benefit of using in vitro interferon-gamma release assays?
M. tuberculosis specific proteins (won't be found in BCG vaccine)
39
What is the most common cause of diarrhea in adults?
Norwalk virus
40
What is a positive tuberculin skin test?
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
41
Hypertension and hyperreflexia, sweating after taking dextromethorpan:
serotonin syndrome
42
How is glycopyrrolate similar/different to/from atropine, hyoscyamine, and transdermal scopolamine?
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.
43
How is glycopyrrolate similar/different to/from atropine, hyoscyamine, and transdermal scopolamine?
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.
44
When do you screen for diabetes?
Adults with BMI > 25 and adults every 3 years starting with age 45
45
Children should sit rear-facing in car seat until
Until the child is at least 12 months old AND weighs at least 20 lb
46
Children should sit rear-facing in car seat until
Until the child is at least 12 months old AND weighs at least 20 lb
47
What is the major and minor criteria for acute rheumatic fever?
```
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
48
What are the goals of treatment for gestational diabetes?
fasting plasma glucose levels below 95 mg/dL and 1-hour postprandial levels below 140 mg/dL
49
Suspect PCV if
- -Hgb >16, WBC > 12, plts > 400
- -splenomegaly
- -PVT
- -elevated leukocyte alkaline phosphatase, elevated B12
50
Treatments for lice?
malathion (most effective), permethrin, pyrethrins (lindane no longer effective)
51
Causes of QT prolongation?
1) congenital
2) hypomagnesemia, hypokalemia, hypocalcemia
3) antipsychotics, TCAs, antihistamines, citalopram, macrolides, class Ia,b and III antiarrythmics
52
Causes of QT prolongation?
1) congenital
2) hypomagnesemia, hypokalemia, hypocalcemia
3) antipsychotics, TCAs, antihistamines, citalopram, macrolides, class Ia,b and III antiarrythmics
53
Which finger is most commonly affected in Dupuytren's?
fourth finger
54
Possible adverse effects of cholinesterase inhibitors (eg donepezil)?
bradycardia and syncope
| tacrine is associated with hepatic dysfunction
55
Possible adverse effects of cholinesterase inhibitors (eg donepezil)?
bradycardia and syncope
| tacrine is associated with hepatic dysfunction
56
Diffuse melanin pigmentation is an oral finding of
Addison's disease
57
Diffuse melanin pigmentation is an oral finding of
Addison's disease
58
How does finasteride affect PSA levels?
Falsely depresses them
59
How does finasteride affect PSA levels?
Falsely depresses them
60
What is the treatment for SYMPTOMATIC multiple myeloma?
autologous stem cell transplant; those who cannot undergo transplant receive melphalan and prednisolone with or without thalidomide
61
What is the treatment for epididymitis?
ages 14-35: 250mg ceftriaxone and 1g azithro (or 100mg BID doxy x 10d)
35: levofloxacin
62
Elevated alkaline phosphatase with elevated 5'-nucleotidase indicates
liver pathology
63
Elevated alkaline phosphatase with elevated 5'-nucleotidase indicates
liver pathology
64
Where are ST changes seen from
1) circumflex occlusion?
2) LAD occlusion?
3) RCA occlusion?
circumflex: I, aVL, V5 and V6
LAD: V1-V6
RCA: II, III, aVF
65
"Baby blues" should resolve within __ days of birth
10
66
What is first-line treatment for PPD in breastfeeding women?
sertraline
67
What is telogen effluvium? Vs anagen effluvium?
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
68
What is the most efficacious medicatoin for allergic rhinitis?
topical intranasal glucocorticoids
69
What is rhinitis medicamentosa?
rebound nasal congestion brought on by extended use of topical decongestants (oxymetazoline, phenylephrine, naphazoline, zylometazoline). DO NOT USE THESE MORE THAN 3 DAYS
70
In the acute phase, which serum protein levels elevate?
| Which decrease?
elevation: ceruloplasmin, complement, haptoglobin, fibrinogen, CRP
decrease: albumin, transferrin
71
What do you measure to assess vit D status?
25-hydroxyvitamin D
| if <20, vit D deficiency
72
Long QT is >___ msec
>460 in females, > 440 in males
73
Which atypical antipsychotic is associated with the least weight gain?
aripiprazole
74
Which atypical antipsychotic is associated with the least weight gain?
aripiprazole
75
The diagnosis of multiple myeloma is confirmed by:
bone marrow showing >10% plasma cells
76
Patients who develop spontaneous PTX (<15% of lung volume) can be managed how?
analgesics and follow-up within 72 hours
77
In stroke patients, high BP is tolerated to SBP ___ mm Hg and DBP ___ mm Hg
SBP < 220; DBP <120. Cautiously only bring down by 10-15% by monitoring neurologic status
78
In setting of pancreatitis, a threefold or greater elevation of ALT has a PPV of 95% for
gallstone pancreatitis
79
Development of a sterile pustule with an erythematous margin within 48 hours of aseptic needle prick...
Behcet's syndrome! (recurrent genital nad oral ulceration and relapsing uveitis with progression to blindness potentially)
80
Chorionic villus sampling can be offered at _____ weeks gestation
Amniocentesis: _______
CVS: 10-13 weeks
Amniocentesis: 16-18 weeks
81
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
true
82
At what age should a more serious condition be worked up if there is no signs of puberty in boys or girls?
age 14 (no breast development in girls, no testicular enlargement in boys)
83
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:
amiodarone
84
Anterior knee pain on climbing stairs/squatting/running; normal range of motion; lateral deviation of patella on extension ("J sign")
patellofemoral stress syndrome. Treat with PT
85
P450 inhibitors:
MAGIC RACKS in GQ
macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir, acute alcohol abuse, ciprofloxacin, ketoconazole, sulfonamides, gemfibrozil, quinidine
86
Dupuytren's disease is associated with which other disease?
When is surgery indicated?
diabetes mellitus. Surgery indicated when contracture reaches 30*
87
WHat is carnett's sign?
easing of pain of abdominal palpation with tightening of stomach muscles. If cause is visceral, should relieve pain vs intrabdominal hematoma, etc
88
The most accurate way to gauge gestational age is ___ in the first trimester
After 11 weeks, _________ is the best way
<11 weeks = crown-rump length
then biparietal diameter
89
The most accurate way to gauge gestational age is ___ in the first trimester
After 11 weeks, _________ is the best way
<11 weeks = crown-rump length
then biparietal diameter
90
How many minutes of exercise is necessary to begin burning fat stores?
30 minutes (glycogen is the energy source for the first 20 minutes)
91
What is the treatment of otitis media in kids?
amoxicillin 80-90 mg/kg/day
92
Skin tags, or arochordons, are associated with
diabetes mellitus and obesity
93
What are some first-line therapies for migraine ppx in adults?
propranolol, timolol, amitryptiline, divalproex sodium, sodium valproate, and topiramate; NSAIDS, CCBs
94
Prominent, warm, papular, and serpiginous skin lesions...
urticaria!
95
How can you distinguish quadriceps tendon rupture from patellar tendon rupture?
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
What is a reactive heart rate?
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
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
12 months
98
What is seen in tarsal tunnel syndrome?
paresthesias in the medial aspect of ankle and heel and sometimes plantar surface of foot with PRONATION
99
Chronic orthrostatic hypotension can be treated by:
fludrocortisone, midodrine, and physostimine
100
What is Osler-Weber-Rendu syndrome? All patients with possible or confirmed should have what screen?
Hereditary hemorrhagic telangiectasia (HHT).
| Should be screened for pulmonary arteriovenous malformations with contrast echocardiography
101
What are the results of the Weber test if the affected ear hears it better? Normal ear?
If affected ear hears Weber (forehead) better: conductive hearing loss
If normal ear hears it better: sensorineural
102
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
elevated liver enzymes (indicating liver inflammation) and the presence of HBeAg
103
What is the inactive carrier phase of HBV characterized by?
clearance of HBeAg and development of anti-HBeAG and normalizatio nof liver enzymes; also reduced levels of HBV virus
104
How do you treat persistent VF?
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
T/F: Up to 75% of patients with cough caused by GERD may have no GI symptoms
true
106
Plaque psoriasis is a lifelong disease, unlike ______ psoriasis which may be self-limited and never recur
guttate
107
Which foods worsen gout? Which improve it?
Worsen: red meat, seafood, and alcohol; nuts and beans
Improve: dairy products
108
a red conjunctiva, a pale fundus, a cherry-red spot at the fovea, and “boxcarring” of the retinal vessels:
central retinal artery occlusion (also with amarousis fugax)
109
What is a positive Thompson sign?
Absence of passive plantar foot flexion when the calf is squeezd = seen with Achilles tendon rupture
110
What can be used for ppx abx for traveler's diarrhea?
for immunocompromised/short trips = rifaximin
111
Most hearing impairments in children are due to
genetic disorders = Waardenburg syndrome, Usher's syndrome, Alport syndrome, Turner's syndrome
112
Why should patients receiving testosterone have Hct monitored q6m until 18m then annually?
T can cause polycythemia
113
For whom is repeat colonoscopy in 3 years recommended?
1) high grade dysplasia
2) 3 or more adenomas
3) adenomas with villous features
4) adenoma > 1 cm in size
114
What are signs of peripheral vertigo?
dizziness with
1) first arising
2) rolling over in bed
3) with nausea and vomiting
115
What are signs of central vertigo?
Diplopia, weakness, difficulty with speech, etc
116
What is ambylopia?
cortical visual impairment from abnormal eye development (often strabismus)
117
What is esotropia, exotropia, and heterophoria?
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
Hearing loss >__ months may indicate need for tympanostomy tubes.
>3 months
119
What are the warning signs for IBS?
rectal bleeding, anemia, weight loss, fever, FH of colon cancer, onset of sx after 50, and a major change in symptoms
120
Locking of knee with extension of knee suggests:
loose body or meniscal tear
121
What is a specific test for rheumatoid arthritis?
anti-CCP
122
Imiquimod can only be used for treatment of external genital and perianal warts in patients ___ years of age and older
12
123
Cow's milk can be started in children __ months and older
12
124
How do you diagnose Kawasaki?
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
What is Waldenstrom's macroglobulinemia?
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
Persistent groin pain, limited hep flexion, limited internal rotation:
stress fractures of the femoral neck
127
Thalamotomy and pallidotomy, contralateral to the side of hte body most affected, are the most effective tx for the unilateral tremor and dyskinesia from
Parkinson's
128
Which drugs might cause serotonin syndrome?
MAOIs, atypical antipsychotics, tramadol, meperidine, sumatriptan, lithium, St John's wort, gingko biloba, sibutramine
129
How do you diagnose preeclampsia?
SBP > 140, DBP >90, 300mg protein in 24 h urine
130
When should phototherapy be initiated?
infants 29-48 hours: 15 mg/dL
49-72 hours: 18 mg/dL
>72 hours: 20 mg/dL
131
Which fluorquinolone should not be used for UTIs?
moxifloxacin
132
What is the most common cause of PNA in children age 4 months to 4 years?
RSV. Mid-winter or early spring!
133
Which antidepressant is associated with withdrawal (agitation, anorexia, confusion, impaired coordination, seizures, sweating, vomiting) after abrupt discontinuation?
venlafaxine
134
How is the pain from fat pad atrophy different from plantar fasciitis?
fat pad atrophy seen in geriatric patients; pain worse as day goes on
135
What is mild intermittent asthma?
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
What is mild persistent asthma?
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
What is moderate persistent asthma?
daytime sx daily and nighttime sx more than 1 night per week. FEV1 60-80% of predicted
138
What is severe persistent asthma?
Continuous daytime sx and frequent nighttime sx. FEV1 <60% or less of predicted
139
T/F: Calcitonin, intranasal or subcutaneous, provides pain relief in a few days in patients with osteoporotic vertebral compression fractures
True
140
The greatest iron demand in pregnancy is in the (first/second) half
first
141
What are some tocolytics?
magnesium sulfate, terbutaline, ritodrine (can all cause resp distress)
Indomethacin and nifedipine do not depress respiration
142
Echinacea is used for
URI. but hasn't been foudn to be very effective
143
What is the management of patient's with Marfan's syndrome and echocardiographic evidence of aortic abnormalities?
placed on B-blockers and monitored with echocardiography every 6 months
144
Which head and neck lymphadenopathy is most likely to be malignant?
supraclavicular
145
If gest age is 12 weeks, ___ mcg
50mcg 12 weeks
146
What is the most common complication of Roux-e-Y bypass?
iron and B12 deficiencies
147
erythroderma accompanied by fever, lymphadenopathy, elevation of liver enzymes, and eosinophilia:
DRESS! Common offending meds are carbamazepine, phenytoin, lamotrigine, phenobarbital. Allopurinol-induced has highest mortality
148
What is normal ABI?
0.9-1.2
149
A new LBBB suggests occlusion of which artery?
LAD
150
Which procedures are linked with the highest incidence of VTE events?
neurosurgical procedures (particularly with penetration of brain or meninges) and orthopedic surgeries (esp of hip)
151
The most common rec for surgical repair of AAA is when it reaches ___ cm in diameter
5.5 cm
152
As long as patients can do activity (greater than __ METS) without cardiac sx, no need for stress testing preoperatively
4
153
Who needs a preoperative EKG?
males over 45, females over 55, patients with diabetes, sx of CP, or a previous hx of cardiac disease
154
A BNP < ___ excludes CHF but >___ is 95% predictive
400 = likely CHF
| Between 100-400 could be PE, pulm cancer, cor pulmonale
155
T/F: Do not use cilostazol in CHF
true
156
Which antihypertensives should we use in older populations?
thiazide, calcium channel blockers
157
Peripheral vascular disease patients have what happen to them after exercise?
decrease in ABI; 20mm Hg or greater decrease in SBP
158
What are the criteria for SEVERE preeclampsia?
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
Red flags indicating possible thyroid cancer in a thyroid nodule:
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
ACe-inhibitors should not be given to a patient with a history of
angioneurotic edema
161
How can you distinguish Meckel's diverticulum from appendicitis?
rectal bleeding in Meckel's, but not appendicitis
162
Which gastroenteritis causing organisms are resistant to chlorine?
Cryptosporidium oocysts and Giardia cysts
163
Treatment of chronic paronchyia:
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
Persistent melasma can be treated with
hydroquinone cream, retinoic acid, and/or chemical peels
165
Painful ingrown toenails that display granulation tissue and lateral nail fold hypertrophy should be treated with:
Excision of the lateral nail plate with lateral matricectomy
166
Which meds for alcohol dependence have the most efficacy?
acamprosate, naltrexone
167
A post-traumatic air-fluid level in the sphenoid sinus is associated with
basilar skull fractures
168
Double vision, fluid in the maxillary sinus, an air-fluid level in the maxillary sinus, and diplopia is associated with:
orbital floor fractures
169
Abduction of the thumb is a function of which nerve?
radial
170
The ability to touch the tip of the thumb to the tip of the little finger is normal motor function of which nerve?
medial
171
What is autonomic hyperreflexia?
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
What are contraindications for TPA in stroke?
blood glucose levels 400 mg/dL, resolving transient ischemic attack, and hemorrhage visible on a CT scan. Time limit 3 hours
173
Why shouldn't meperidine be used in geriatric patients?
metabolite can accumulate and cause seizures
174
Which parasomnias occur in the first half of the night? which the second?
first half = nREM sleep = sleepwalking, sleep terrors, confusional arousal
second half: nightmares
175
Which antipsychotic should be used in Parkinson's?
quetiapine (doesn't affect D2 receptor)
176
Which SSRI is least likely to inhibit cytochrome P450?
citalopram; use for multiple comorbidities
177
How do progesterone levels predict fetal outcome?
>25 = healthy pregnancy; <5 = nonviable
178
What are the Amsel criteria?
```
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
What is the most common symptom of vulvar cancer?
longstanding pruritus
180
At 35-37 weeks gestation, cultures of GBS must be taken from where?
vaginal introitus and rectum (GI tract is the most likely reservoir of GBS)
181
Colpitis macularis (strawberry cervix) is associated with which vaginal infection?
Trichomonal vaginitis
182
What is the most common histologic diagnosis in patients evaluated for AGUS?
cervical intraepithelial neoplasia
183
Metronidazole gel and clindamycin are useful for treating _______ but ineffective for _______
can treat BV but not trichomonas
184
When is postterm pregnancy?
42 weeks! perinatal mortality doubles there
185
Simple ovarian cysts that are less than __ cm in size, as long as they are asymptomatic, can be monitored with ultrasound in 2 months
<8 cm in size
186
Miliary lesions in CXR think of
histoplasmosis, miliary TB
187
The CXR of a child with meconium aspiration syndrome will show
patchy atelectasis or consolidation
188
What will the CXR of a patient with transient tachypnea of the newborn show?
wet silhouette around the heart, diffuse parenchymal infiltrates, or intralobar fluid accumulation
189
What will the CXR of a child wtih hyaline membrane disease show?
air bronchograms
190
What are risk factors for transient tachypnea of the newborn?
C section, macrosomia, male gender, maternal asthma and or diabetes
191
CAP should be treated with azithromicin unless...
treated within the previous 3 months with abx. Fluoroquinolone should then be used, or a B lactam and a macrolide!
192
What is the most common presenting symptom of glaucoma?
tunnel vision
