AFM questions

Question 1

haloperidol

Answer 1

effective treatment for acute mania in bipolar disorders, but not for maintenance therapy or acute depression

Question 2

maintenance therapy drugs for bipolar disorder

Answer 2

Lithium, valproate, lamotrigine, and some antipsychotics (including quetiapine) are effective treatments
for both acute depression and maintenance therapy of bipolar disorders

Question 3

necrotizing fascitis presentation

Answer 3

right hand and arm pain and a rapidly expanding
area of redness. On examination he has a temperature of 38.9°C (102.0°F), a pulse rate of 120
beats/min, and a blood pressure of 116/74 mm Hg. He also has erythema from the dorsal hand
to the elbow, violaceous bullae on the dorsal hand and wrist, and severe pain with dorsiflexion
of the wrist or fingers.
Severe pain and skin changes outside the realm of cellulitis, including bullae and deeper
discoloration, are strong indications of necrotizing fasciitis. Antimicrobial therapy is essential but is not
sufficient by itself; aggressive surgical debridement within 12 hours reduces the risk of amputation and
death.

Question 4

amiodarone SFx

Answer 4

hyperthyroidism or hypothyroidism. It is recommended that a patient on amiodarone have baseline thyroid function tests (free T4, TSH) with follow-up testing every 6
months to monitor for these conditions. Hyperadrenalism and hypoadrenalism are not associated with
amiodarone treatment.

Question 5

Radial head subluxation (nursemaid’s elbow)

Answer 5

MCC of elbow problem in kids 1-4
partial displacement of the radial head when the child’s arm
undergoes axial traction while in a pronated and fully extended position. 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.
As long as there are no outward signs of fracture or abuse it is considered safe and appropriate to attempt
reduction of the radial head before moving on to imaging studies. With the child’s elbow in 90° of flexion,
the hand is fully supinated by the examiner and the elbow is then brought into full flexion. Usually the
child will begin to use the affected arm again within a couple of minutes. If ecchymosis, significant
swelling, or pain away from the joint is present, or if symptoms do not improve after attempts at reduction,
then a plain radiograph is recommended.

Question 6

first line treatment for dysmenorrhea

Answer 6

The first-line treatment for primary dysmenorrhea should be NSAIDs (SOR A). They should be started
at the onset of menses and continued for the first 1–2 days of the menstrual cycle. Combined oral
contraceptives may be effective for primary dysmenorrhea, but there is a lack of high-quality randomized,
controlled trials demonstrating pain improvement (SOR B). They may be a good choice if the patient also
desires contraception. Although combined oral contraceptives and intramuscular and subcutaneous
progestin-only contraceptives are effective treatments for dysmenorrhea caused by endometriosis, they are
not first-line therapy for primary dysmenorrhea.

Question 7

when find thyroid nodule you…?

Answer 7

if > 1 cm, get TSH or US
if < 1 cm, only f/u if family hx or personal hx of irradiation to neck

if TSH results abnormal, do radionucleotide scan
Diagnostic ultrasonography is
recommended for all patients with a suspected thyroid nodule, a nodular goiter, or a nodule found
incidentally on another imaging study

Question 8

drug that causes steven-johnson syndrome

Answer 8

Lamotrigine - anti epileptic
most
commonly occurs in children or when the drug is initiated at a high dosage, and is also more likely to occur
in patients taking divalproex

started at a dosage of 25 mg daily and titrated every 2 weeks until the goal dosage
is reached.

Question 9

prophylaxis for flu

Answer 9

The occurrence of two or more laboratory-confirmed cases of influenza A is considered an outbreak in a
long-term care facility. The CDC has specific recommendations for managing an outbreak, which include
chemoprophylaxis with an appropriate medication for all residents who are asymptomatic and treatment
for all residents who are symptomatic, regardless of laboratory confirmation of infection or vaccination
status. All staff should be considered for chemoprophylaxis regardless of whether they have had direct
patient contact with an infected resident or have received the vaccine. Requesting restriction of visitation
is recommended; however, it cannot be strictly enforced due to residents’ rights.

Question 10

erythema toxicum neonatorum

Answer 10

flesh-colored papules with an erythematous base
located on the face and trunk, containing eosinophils.
observe - resolves in a week or two
cause unknown

Question 11

asymptomatic microscopic hematuria

Answer 11

≥3 RBCs/hpf on a properly collected urine specimen in the absence of an obvious benign cause

Question 12

tx of dyspnea in terminally ill patients

Answer 12

In the absence of hypoxia, oxygen
is not likely to be helpful. Opiates are the mainstay of symptomatic treatment and other measures may be
appropriate in specific circumstances. For example, inhaled bronchodilators or glucocorticoids may be
helpful in patients with COPD, and diuresis may be helpful in patients with heart failure. The evidence for
oxygen in patients with hypoxemia is not clear, but there is no benefit from oxygen for nonhypoxemic
patients.

Question 13

ischemic colitis

Answer 13

crampy lower abdominal pain and bloody diarrhea
mild abdominal
tenderness and slightly decreased bowel sounds
afebrile, and a nasogastric aspirate is negative for evidence of bleeding

ddx:
Diverticular bleeding and angiodysplasia are painless. Infectious colitis is
associated with fever

Question 14

sfx of inhaled corticosteroids

Answer 14

increase the risk of bruising, candidal infection of the oropharynx, and pneumonia.
They also have the potential for increasing bone loss and fractures

decrease risk of COPD exacerbations but no effect on mortality, don’t change FEV1

Question 15

benign nocturnal limb pains of childhood

Answer 15

crampy pains often occur in the thigh, calf, or shin, occur in up to 35% of children 4–6 years of age, and
may continue up to age 19
pain is nocturnal, without
limping or other signs of inflammatory processes

Question 16

polymyalgia rheumatica

Answer 16

10-day history of bilateral shoulder pain and stiffness
accompanied by upper arm tenderness. On examination there is soreness about both shoulders
and the patient has great difficulty raising his arms above his shoulders. There is no visual
disturbance, and no tenderness over the temporal arteries. C-reactive protein is elevated and the
erythrocyte sedimentation rate is 65 mm/hr (N 0–17).

prevalence increases
with age in older adults but is almost never seen before age 50

fatigue, weight loss, low-grade fever, a decline in appetite, and depression

no validated diagnostic criteria available to assist in the diagnosis

treatment response to 15
mg of prednisone daily is dramatic, often within 24–48 hours, and if this response is not seen, alternative
diagnoses must be considered

Question 17

tx of diabetic foot ulcers

Answer 17

Piperacillin/tazobactam and
vancomycin
cover the most
common pathogens in diabetic foot ulcers, as well as MRSA, which is present in 10%–32% of diabetic
foot ulcers

Moderate to severe diabetic foot ulcers are often polymicrobial and can include gram-positive
cocci, gram-negative bacilli, and anaerobic pathogens