ABFM 2018 50-100 Flashcards
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34 y/o F with 3 month history of nonproductive cough.
Exam-negative.
Rx: intra-nasal corticosteroid.
68-year-old female presents with a history of episodic severe lower abdominal pain relieved by defecation.
Dx:IBS
Rx: Polyethylene glycol.
Distal biceps tendon rupture.
Dx: MRI of elbow.
72-year-old male with DM II takes Glucophage 1000 mg twice a day; BMI 32; hemoglobin A1c 9.5 .
Rx: Start basal insulin at 10 u/ day.
47-year-old male with bilateral L/Ext. edema with fatigue. Lipid levels were high; thyroid function normal with a positive periorbital edema
Dx: Nephrotic Syndrome; + urine proteinuria.
66-year-old female with bone metastasis having breakthrough pain. Given 10 mg of oxycodone 15 minutes ago.
Last dose peak effect one hour after given.
62-year-old female with history of COPD FEV1 165% PaO2 57; Dx: Pulmonary hypertension.
Rx: supplemental oxygen.
Antihypertensive drug that may reduce severity of sleep apnea.
Spironolactone (Aldactone).
US preventative services task force absolute risk reduction for developing diabetes mellitus.
1/7
25-year-old female with irregular menses, her to resume and moderate acne prefers not to be pregnant.
Rx: Levonorgestrel/ethinyl estradiol
68-year-old male with chronic right knee pain from osteoarthritis. Tylenol and NSAIDs - limited help.
Rx: A low impact aerobic exercise program.
52-year-old female with a history of gastric bypass, DJD of both knees and shoulder and chronic LBP.
Rx: Taper oxycodone by 5%-10% every 1-4 weeks.
13-year-old male with pain and throwing arm with no history of acute injury.+Tenderness over proximal and lateral humerus.
Dx: Plain x-ray to distinguish rotator cuff pathologies from disruption o proximal growth plate of the humerus.
30-year-old female with an episode of recurrent painful vesicular lesions on the labia with tingling sensation a few days before the lesions appeared.
Rx: Valacyclovir (Valtrex).
62-year-old Asian female with pain and redness in her left eye since last night. Now has headache, light sensitive sensitivity and mild nausea. Visual acuity 20/100 on left,
Rx: Emergent evaluation by ophthalmologist.
Dx: Acute angle-closure glaucoma.
24-year-old female with a history of bulimia nervosa . Which drugs has an increased risks of seizures in these patients?
Bupropion (Wellbutrin).
3-year-old male with in turning toes and clumsy gait. Dx: Internal tibial torsion.
Rx: Observation;Surgery after age 8, if no resolution.
24-year-old female with recent onset of coughing when running. Normal spirometry..
Rx: An inhaled short-acting beta 2 agonist 15 minutes before running.
Malignancy associated w Hereditary Hemochromatosis
Hepatocellular Carcinoma.
62-y/o F admitted to hospital for intractable nausea and vomitinng with volume depletion and hypotension. Living in New Mexico; cleaning out chicken coop with rodents. Blood cultures positive for gram-negative rods.
Dx: Yersinia pestis. (Western U.S.)
21-year-old female with secondary re hypertension. What test is most specific for fibromuscular dysplasia?
Magnetic resonance angiography of the renal arteries.
Greatest risks for developing knee osteoarthritis as an older adult.
Obesity.
88-year-oldd female at assisted living facilities with chronic urinary incontinence. Afebrile with urine culture greater than 100,000 Escherichia coli.
Rx: No antibiotics. (Asymptomatic bacteriuria).
61-year-old white M w DM II- wll-controlled BP 156/94;
Rx: Add an Ace Inhibitor.
66-year-old w previous h utilized motivationalx of HTN, and carotid endarterectomy presents with acute upper abdominal pain past 3 hours. (Suspect Mesenteric Ischemia)
Dx: CT angiography.
38-year-old female with migraine headaches wishes to start contraception.
Rx: Estrogen-containing products including patch and vaginal ring are contraindicated in patients with migraines.
45-year-old M truck driver with HTN and DM and obesity.. His BP is 166/94 and hemoglobin A1c is 9.7
Rx: Utilized motivational interviewing to explore patient’s level of desire to change.
47-year-old male attempts to climb Mt. Rainier. First day he ascends to 11,000 feet. Next morning he has a headache nausea dizziness and fatigue. As he climbs a becomes ataxic and confused
Rx: Administration of oxygen and immediate descent.
68 y/o M with basal cell CA; which procedure has highest rate of cure?
Rx: Mohs surgery.
55-year-old female pre-op evaluation for cataract surgery. Previous history of diabetes mellitus I. cardiovascular and pulmonary examinations are unremarkable.
No further preoperative evaluation necessary.
New anticoagulants-Eliquis. Pradaxa, Savaysa & Xarelto before starting get:
Renal Function.
42-year-old male alcoholic with his last drink 7 days ago asked for medication.
Rx: Acamprosate (ETOH).
46 y/o M 40 pp year hx of smoking presents with 2 month history of dyspepsia and difficulty swallowing reports 20 lb weight loss & takes Prilosec.
Dx: Upper endoscopy (Esophageal CA ?)
16-year-old white male with sports preop:Ht.-6’2”,wt.-152 lbs. w long arms,high arched palate, kyphosis,myopia,& pectus excavatum.
Dx: Marfan’s Syndrome (Aortic Insufficiency).
46 y/o M with 30 year hx of smoking w multiple episodes of quarter size bloody emesisis over the past few days; chest x-ray negative.
Dx: CT of chest with contrast.
68 y/o F with SOB with activity over the past few weeks, also reports lower extremity edema patient has hx of by tricuspid aortic valve and aortic stenosis. Ejection fraction estimated at 50%.
Rx: Referral for aortic valve replacement.
45 y/o F with IBS as a six-month hx of crampy, diffuse abdominal painn associated with defecation. According to the for Rome IV criteria and associated Sx would be-?
A change in stool frequency.
the U.S. Preventatiive Services Task Force recommend diabetes mellitus no sooner than:
24 weeks gestation.
20-year-old football player presents with pain in the fifth proximal metatarsal. + tenderness to palpation. Plain films show no signs of fracture.
Dx: MRI of foot. (Stress fracture ?).
84 y/o F with severe dementia secondary to Alzheimer’s disease is a resident of long-term care facility. She has shown increase aggression staff and other residents. Unsuccessful management of Sx’s; suggests starting low-dose Risperdal.
Potential side-effect: Inc. risk of mortality.
Diabetes treatment most likely to cause weight gain?
Glimepiride (Amaryl).
34-year-old healthy female presents with 1 hour history of palpitations. (EKG shows atrial fib).
Dx: Get TSH ( Subclinical Hyperthyroidism).
14-year-old male with 2 month history of left breast lump. PE: Slightly tender area of concentric firm mobile tissue under left areola No skin changes, nipple disch or at the adenopathy.
Rx: F/U in 6-12 months (Gynecomastia).
52y/o M presents with long-standing facial rash that is itchy, flaking and scaling around his mustache and nasolabial folds.
Dx: Seborrheic dermatitis;Rx: Topical fungal agents.
58-year-old male routine health visit has 20-pack-year smoking history but has stopped 1 year ago. U.S. Preventative Services Task Force recommends:
Hepatitis C Screening.
a 30-year-old female postpartum 3 months mild depressions in the past 7 weeks. Little joy in daily activities and not interacting with baby. U rule out postpartum psychosis and bipolar disorder
Rx: Appropriate treatment is referral to psychotherapy.
Preferred treatment for rheumatoid arthritis.
Rx: Methotrexate (Trexall).
68 y/o F with controlled HTN and OA of knee with BMI of 36. Scheduled for elective total knee replacement.
Rx: Start statin immediately to decrease risks of cardiovascular disease & peri-operative mortality
40 y/o M presents with clean catch U/A -5 red blood cells/hpf on microscopy.
Dx: Cystoscopy.
68-year-old female presents with a 3 month history of low back pain and fatigue. She also has unintentionally lost 15 pounds. Positive PE for vertebral point tenderness over t lumbar vertebrae. Lab: Normocytic anemia elevated total protein and mild decrease in renal function.
Dx: Serum protein electrophoresis (multiple myeloma).
48-year-old female with type 2 diabetes mellitus first line for initiating treatment.
Metformin (Glucophage).
22-year-old female prevent for evaluation of nasal and sinus congestion, frequent sneezing and itchy red eyes.
RX: Intranasal Budesonide (Rhinocort).
Elderly male presents with venous ulcer,
Rx: Compression therapy.
Most reliable measure to protect children from lead toxicity in the US
Eliminating the sources of lead in the community.
64 y/o female with HTN, DM, HLD and CKD with headaches.
Dx: MRI should not include use of gadolinium contrast,
29-year-old gravida 2 para 1 scchedule for induction of labor, Which one should be avoided to minimize the risks of postpartum hemorrhage in this patient
Routine episiotomy.
64-year-old male with midsternal chestt pain in ER with oxygen and IV line in place. Shortly after a viral he loses consciousness and be called once apnei and pulseless; CPR is initiated V. tach at 160.
Rx: Defibrillation.
Patients with COPD shown to reduce exacerbations with—-
Rx: Tiotropium (Spiriva).
52-year-old male with a BMI of 33.2 with mild elevations in ALT and AST.
Dx: Get serum ferritin (R/O Hereditary Hemachromatosis).
62-year-old white male with a 3 month history of diabetes mellitus with hemoglobin A1c of 7.8. Which test indicates whether he can safely take metformin (Glucoophage).
Estimated glomerular filtration rate’
43-year-old male with 6 week history off right ankle pain. No history of fall pain localized inn the right Achilles tendon area proximal to the insertion.
Initial treatment: Eccentric gastrocnemius-strengthening program.
45-year-old male presents with a Hx of 2 months nonpproductive cough, SOB, fatigue and 5 pound weight loss. Examination PPD negative lungs clear, chest x-ray shows bilateral hilar adenopathy and angiotensin converting enzyme level is elevated. Biopsy of lymph node showed noncaseating granuloma.
Rx: Prednisone.
40-year-old white female with history of anxiety, insomnia, fatigue, persistent depressed mood and low libido.
Dx: Dysthymia.
Vaccine recommended for all women with each pregnancy.
Tdap.
26-year-old male presents with rash on his anterior neck in the area of his beard past year with curly facial hair and tender red papules on the superior anterior neck.
Rx: Shave with electric clippers.