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AFP boards > BL inservice exam > Flashcards

BL inservice exam Flashcards

1
Q

How would you confirm Legionnaires disease?

A

Urine testing for Legionella pneumophila antigen

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2
Q

During pregnancy, what increases the risk of hip dysplasia in the infant?

A

Breech Presentation

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3
Q

If a parent refuses to vaccinate their kid, what does the CDC recommend you do?

A

Have the parents sign a refusal to vaccinate form

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4
Q

Carpet layer has swelling of the R knee proximal to the patella. No systemic syx. Knee is swollen but minimally tender. How do you manage?

A

RICE

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5
Q

What is a pt’s history (HTN, CHF, TIA, PUD, ischemic stroke, T2DM) is an absolute contradiction to fibrinolytic therapy

A

Ischemic stroke

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6
Q

57 F with sudden onset L hearing loss. Weber materializes to R side. Rinne is heard better on the L. You refer to ENT, but what else do you need to start?

A

Prednisone

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7
Q

High school kid inverts foot during a game. Pain is across the mid foot and edema over lateral malleolus and diffuse tenderness. No pain of the navicular, base of 5th metatarsal, posterior distal lateral or medial malleoli. How do you manage?

A

Lace up ankle support, ice, compression, and clinical follow-up

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8
Q

Pt has SOB, responsive to steroids and albuterol, chronic cough, blurry vision. CXR with pan lobular basal emphysema. FEV1/FVC < 0.7, not reversible with inhaler. Dx?

A

alpha1-antitrypsin deficiency

Other options: ILD, bronchiectasis, and diffuse panbronchilitis cause cough but do not cause FEV1/FVC changes.

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9
Q

CXR finding in bronchiectasis

A

Bronchial dilation and bronchial wall thickening

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10
Q

CXR findings in ILD

A

Reticular or increased interstitial markings

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11
Q

CXR findings in diffuse panbronchiolitis

A

Diffuse small centrilobular nodular opacities along with hyperinflation

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12
Q

Male has low testosterone c/w hypogonadism, what workup would you recommend next?

A

Check FSH/LH
Helps distinguish between primary and secondary hypogonadism
Low/normal FSH/LH suggest secondary
If primary - karyotype for klinefelters
If secondary - check prolactin, Iron, TIBC. May consider MRI

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13
Q

Tx for constipation in 4 y/o

A

PEG
More effective than lactulose, Senna, Mag hydroxide
No evidence to support fiber

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14
Q

IVDU with fever but all other vitals ok. What is important?

A

Blood cultures - high risk for bacterial endocarditis even if not septic.

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15
Q

Newborn exam, front half of foot turns inward and with gentle pressure your are able to straighten the foot into normal alignment. Now what?

A

Observation
Dx - flexible metatarsus adducts, most common congenital foot deformity
Usually spontaneously resolves by 1 y/o
If you were unable to straighten on exam (ie rigid metatarsus) pt would require serial casting

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16
Q

35 y/o F with tremor. Jerking movement in one hand, then the other. Syx resolve when she is distracted. NL Neuro exam. Dx?

A

Psychogenic tremor

Characterized by abrupt onset, spontaneous remission, resolves with distraction

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17
Q

Symmetric fine tremor involving wrist, hands, head, lower extremities

A

essential tremor

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18
Q

Patient with dementia has been on Seroquel for 6 months and doing well on it. Taper or no?

A

Patients who have been on antipsychotics for >3 months and doing should undergo a slow taper (d/t risk of AE’s; increased mortality, falls, CVA, EPS symptoms). Reduce by 25% every 2 weeks

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19
Q

Young health care working traveling to TB endemic area. What is your rec?

A

PPD or quantiferon before travel
If negative, repeat testing 8-10 weeks after return
Don’t need PPx treatment

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20
Q

Young pt with fatigue, hair loss, weight gain. TSH elevated, T4 low, TPO elevated. Thyroid not palpable. Dx and Tx?

A

Hashimoto thyroiditis

Start levothyroxine and recheck TSH in 6-8 weeks.

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21
Q

Primary RF for successful suicide in men?

A

Access to firearms or other lethal weapon

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22
Q

Patient has Type II AV block on EKG (in setting of known sarcoidosis). What does he need?

A

Evaluation for pacemaker

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23
Q

Pt couldn’t tolerate 40mg Lipitor. Now what?

A

Can do a trial of moderate intensity statin. Ezetimibe + statin has been shown to be helpful

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24
Q

Patient has dupuytren’s contracture (trigger finger + palmar nodule). Tx?

A

Surgical release if the contracture is over 30 degrees

If less than 30 can do steroid inj

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25
Q

Patient is about to travel and worrying about travelers diarrhea. What med would you recommend

A

Short course of Azithromycin if she develops diarrhea
Can help shorten duration of syx
No real ppx tx

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26
Q

Criteria in CURB-65

A 
Confusion/AMS
Uremia (BUN >20)
Respiratory rate >30
Hypotension
Age > 65
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27
Q

Elderly patient has lost interest in his usual activities. What do you do next?

A

PHQ-9

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28
Q

USPTF recommendation to prevent fall in folks >65?

A

Regular participation in an exercise program

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29
Q

Pityriasis rosea is a generally benign disease except for in?

A

Pregnancy

Increased risk of SAB in 1st trimester

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30
Q

50ish y/o M with 1 month of pain in hands and elbows. Swelling of wrist, MCP, and PIP joints. Xray with diffuse bony erosions of MCP and PIP joints. DX?

A

Rheumatoid arthritis

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31
Q

9 y/o with close contact to TB positive person has a PPD with 8mm induration, NL CXR. Now what?

A

> 5mm induration = positive test for those in close contact w/ someone with TB, + CXR or HIV/immunosuppressed
NL CXR –> latent TB
Kids 2-11 –> isoniazid qd x 9 months
adults –> isoniazid x 6 mo, rifampin

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32
Q

should a shellfish allergy discourage you from getting IV contrast?

A

No. no premedication is needed

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33
Q

Patient has shoulder weakness when shoulder is adducted and elbow bent to 90 and cannot keep her hand lifted behind her back. Injury in which tendon?

A

Subscapularis

causes weakness in internal rotation

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34
Q

What supplement helps improve quality of life in tinnitus?

A

Cognitive Behavioral Therapy

Helps to reduce awareness of tinnitus

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35
Q

28 y/o F PCOS goal is to avoid menorrhagia. Best initial tx?

A 
IUD
best 1st line in a patient not interested in fertility
Metformin - treats IR
Dietary modification - treats obesity
spironolactone - hirtuism, acne
clomiphene - induce fertility
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36
Q

6 m/o with rhinorrhea and wheezing but other vitals WNL. Tx?

A

supportive care

viral bronchiolitis

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37
Q

IN asymptomatic sarcoid patients, what extra pulmonary organ should be examined yearly?

A

Eye
Eye inflammation can cause permanent impairment in otherwise asymptomatic patients
Skin - usually obvious, not dangerous
heart - typically only problematic in symptomatic sarcoid

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38
Q

Work up for syncope should include

A

Orthostatics and EKG

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39
Q

60ish guy on routine labs with normocytic anemia, next step?

A

Get iron studies

If IDA should get C-scope

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40
Q

Heel pain, nodular appearance at insertion site of Achilles. Management?

A

PT and eccentric calf strengthening exercises

Dx - Achilles Tendinopathy

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41
Q

F patient with libido issues on Zoloft, what do you do?

A

Switch to bupropion

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42
Q

Patient with chronic redness, flaking, discomfort of eyelids and eyes feel dry/sandpapery at times. Tx?

A

Warm compress and mild shampoo
Dx - blepharitis, chronic inflammation of eye lids
Caused by seborrhea or staph
Can do abs if resistant

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43
Q

T2DM patient asks you about nonnutitive sweetners. What’s your rec?

A

Nonnutritive sweetners are acceptable

should be used in moderation

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44
Q

30ish healthy female rhinorrhea, loss of sense of smell x 4 months. On exam swollen nasal turbinates and mucopurulen discharge, dx?

A

Chronic rhino sinusitis

Presence of at least 2 of: nasal drainage, nasal obstruction, facial pain/pressure, hyposmia/anosmia

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45
Q

Pt with metastatic cancer has new back pain x hours worse with laying down. What does she need?

A

An urgent MRI
suspicious for epidural spinal cord compression
can be an oncologic emergency
Most commonly associated with breast cancer
If confirmed need urgent steroids and NSGRY intervention to preserve motor/sensory function

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46
Q

Most appropriate initial test to dx pHTN?

A

Echo

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47
Q

Runner has knee pain x 1 week without acute injury. Normal gait. TTP/swelling 1 cm distal to medial joint line. Dx?

A

Pes anserine bursitis

Medial knee pain 2/2 overuse

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48
Q

Vaginitis with malodorous greenish-yellow froth discharge w/ inflammation of cervix and vagina, dx?

A

Trich

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49
Q

Long term risk of Mumps?

A

Orchitis that can cause decreased fertility
Prodrome: myalgia, fatigue, loss of appetite, fever, headache
syx: parotitis
Complications: Infertility, meningitis, encephalitis

50
Q

Prodrome of cough, coryza, conjunctivitis, Koplik spots

A

Measles

51
Q

Childhood dz with fluid filled blisters

A

Varicella

52
Q

Which DM medication increase risk of recurrent yeast infections?

A

SGLT2 inhibitors

like Jardiance

53
Q

PReggo @ 34wks has diffuse itching and excoriations. Next step?

A

Get LFTs and Sr Bile levels
Get worried about cholestasis of pregnancy anytime a preggo has itching
Associated with fetal mortality and can be indication for late pre term induction

54
Q

At which MME should you prescribe naloxone?

A

50 MME

55
Q

ESRD pt has hypocalcemia. Why?

A

Still secondary hyperPTH, Bone mineral dz

High phos, high PTH, the high PTH can bind up calcium making low, or can promote bone break down making the calcium high

56
Q

TX for Charcot neuropathy

A

Immobilization 3-4 months

57
Q

At what age should kids be able to point to picture or body parts?

A

2 years

58
Q

When is allergy testing helpful?

A

When pt have frequent viral URI syx

NOT drug allergy rxns

59
Q

When are fibrinolytic indicated for STEMI?

A

If there is an anticipated 2 hour delay before pt can get cath’d

60
Q

At what ages can you offer low dose CT screening for lung cancer?

A

55-80
30 pyx
quit less than 15 years ago

61
Q

7 y/o with BP in 95th percentile needs?

A

Renal US
Renal etiologies are the most common cause of HTN in pre-adolescents
w/u for teen is different

62
Q

Tx for non displaced tuberosity avulsion of 5th metatarsal

A

Compressive dressing w/ weight bearing and ROM exercise as tolerated

63
Q

Tx for minimally displaced (> 0 mm but <3mm) tuberosity avulsion of 5th metatarsal

A

Walking boot

64
Q

Tx for displaced tuberosity (>3mm) avulsion of 5th metatarsal

A

Surgery

65
Q

Long term Tx for WPW

A

Ablation

Not BBlock and ND CCB b/c of risk of converting to Vfib

66
Q

Elderly pt presents after a choking episode. Gradual difficulty with swallowing over last several months. Modified barium swallow shows collection of barium in the throat in a pouch. Dx?

A

Zenker’s diverticulum
Most common structural lesion in elderly
Caused by stenosis of cricopharynxgeus and increased hypo pharyngeal pressure d/t swallowing that causes diverticulum above criopharyngeus

67
Q

What would be seen on barium swallow for cervical web or Schatzki ring?

A

Short segment of narrowing w/o diverticula

68
Q

What would be seen on barium swallow for tracheoesophageal fistular?

A

Barium would be in the trachea

69
Q

What intervention is most beneficial to improve physical function in an elderly patient?

A

Resistance training

Helps to reduce frailty before introducing aerobic exercise

70
Q

Term for spoon shaped nail

A

Koilonychia

Associated with multiple systemic dz ( iron deficiency, hypothyroid, SLE)

71
Q

Thick soft tissue proximal to nail bed

A

Clubbing

72
Q

White discoloration of nail plate

A

Leukonychia

Normal variant

73
Q

Thick, yell, dystrophic nail

A

Onychomycosis

74
Q

Oncologic etiology of erythematous, proliferating mass disrupting normal nail morphology

A

Squamous cell carcinoma

75
Q

Immunotherapy can help with severe allergic rxns to?

A

Seasonal allergens

Wasp stings

76
Q

Asyx IVDU presents to establish care. What screenings do you order?

A 
HIV 
Hep A
Hep B
Hep C
TB
77
Q

Asyx IVDU presents to establish care. What screenings do you order?

A 
HIV 
Hep A
Hep B
Hep C
TB
78
Q

Tx for PNA pt admitted from a nursing home?

A

CTX/Azithro

Treat like a cAP

79
Q

13 y/o F Tanner 3 wants gender affirming tx to become M. Parents supportive. Now what?

A

Offer gonadotropin releasing hormone analogue treatment

Should only be offered with pt is tanner 2 or 3

80
Q

concerning finding to suggest poor breast feeding on exam

A

Infants cheeks are dimpled - suggests poor latch
signs of good latch - most or all of areola cannot be seen, chin pressed against the breast, everted nipples
yellow stools is also a positive sign

81
Q

concerning finding to suggest poor breast feeding on exam

A

Infants cheeks are dimpled - suggests poor latch
signs of good latch - most or all of areola cannot be seen, chin pressed against the breast, everted nipples
yellow stools is also a positive sign

82
Q

Most common infection in a IVDU

A

Cellulitis

83
Q

Thumb pain after a fall
Pain at medial MCP joint
mild laxity in her ulnar collateral ligament with 30 degree of joint opening with abduction stress to distal them while stabilizing the metacarpal (vs. 15 degrees on R). Tx?

A

Thumb spica x 6 weeks
Dx - Ulnar collateral Ligament disruption “skier’s thumb”
Can lead to joint instability and weak pincer grip if untreated
Indications for Surgery - avulsion fx, 35-40 degrees of joint opening, no end point on abduction stress

84
Q

Thumb injury w/ joint instability and tender mass

A

Stener lesion
Entrapment of Ulnar collateral ligament outside of the adductor aponeurosis
Needs urgent ortho referral

85
Q

Which lab test is best at assessing thyroid function?

A

TSH
best test to dx hypothyroid and is also Abnormal in hyperthyroid
T4 is indicated if TSH abnormal

86
Q

Sexual development disorder associated with increased risk of endometrial CA, Celiac dz, Structural heart defect

A

Turner syndrome

87
Q

Most common cause of chronic cough in adults

A

Upper airway cough syndrome (AKA PND syndrome)
Tobacco use
ASthma
ACEI

88
Q

Starting someone on allopurinol and what else do you start for ppx?

A

Colchicine or NSAIDs
Reduce risk of gout attacks during urate lowering therapy
Exact length is unclear, but should be at least 8 weeks

89
Q

Pt with HTN has hypercalcemia with NL albumin levels. What med do you consider stopping?

A

HCTZ

Can also check PTH function

90
Q

Pred dosage for COPD admitted to hospital

A

40mg QD x 5 days

91
Q

Pattern of hairless in Female with androgenetic alopecia?

A

Diffuse thinning of hair along vertex, sparing among frontal hairline

92
Q

17 y/o F closed comedones on nose, forehead chin. No cystic lesions or body acne. Tx?

A

Topical adapalene and benzoyl peroxide
considered mild acne d/t being limited to T zone
1st line for any severity of acne = retinoids
Adapalene is a retinoid available OTC
Benzoyl peroxide reduces concentration of cystic acne w/ no risk of bacterial resistance
Combo of retinoid and benzoyl peroxide is superior to mono therapy
Avoid TOP abx (Glinda erythro) as mono therapy d/t rate of resistance
Little data supports effectiveness of alicyclic acid
Tazarotene is effective but should be avoided in reproductive age F
Can do OCPs for norethindrone (1st gen progesterone) can worsen acne

93
Q

People living in rural areas fit what demographics?

A

Tend to be older and poorer

94
Q

Tx for heatstroke

A

immersion in a ice bath until T<102

if not available - ice pack, cold IVF, evaporative cooking, immersion of extremities work too

95
Q

Giving a patient a pencil and asking them how it is used is assessing their?

A

Praxis - ability to carry out intentional motor acts with common objects (hair brush, pencil)

96
Q

Asking pt to draw a clock asses their

A

executive function

97
Q

Asking a pt to name objects and their function asses?

A

Gnosia

98
Q

Kiddo with Celiac should have what screening annually?

A

IgA TTG
If it does not decrease after 6 months of diet change, it would suggest that kiddo is still eating gluten and needs additional dietary modification

99
Q

How do you handle post exposure prophylaxis after a measles exposure?

A

Kids < 12 months should get vaccine within 72 hours of exposure
pregnant women who are NI should get IVIG
Fully vaccinated folks done need it

100
Q

Most common meds causing hyponatremia

A

SSRIs

Diuretics

101
Q

pregnancy increases risk of which dental issues?

A

cavities
loose teeth
gingivitis
periodontitis

102
Q

Tx for pt with acute symptomatic urinary retention?

A

Foley x 3 days
Start alpha blocker while it is in
Intermittent cath wouldn’t give chance to correct underlying issue

103
Q

What med should be stopped 4-6 weeks before getting a plasma Aldo:renin?

A

Spironolactone - increases aldosterone

ACEI/ARB - increase renin

104
Q

Tx for delirium in hospice pt

A

Risperiodone

105
Q

kiddo with one time seizure, self resolved, normal work up incl eeg. Now what?

A

don’t start meds

106
Q

indications to screen for developmental dysplasia of hip

A

breech in 3rd trimester
Fix developmental dysplasia of hip
Personal hx of instability
Other RF - female, first born, oligohydramnios, LGA

107
Q

Recommendation for fluoride supplementation?

A

Start supplementation at 6 m/o if the primary water supply is fluoride deficient

108
Q

Kiddo has rheumatic fever. Tx?

A

NSAIDs (ASA or Naproxen)

NOT Tyl

109
Q

Tx for Takotsubo at discharge?

A

Diuretic
ACEI
Beta blocker
Until syx and Echo abnormalities resolve

110
Q

which patients struggle with MDI?

A

Pts > 75
Female
Low SES
Severity of dz and presence of comorbidities

111
Q

Tx for croup

A

po dex 0.6mg/kg

Even if pt has mild stridor

112
Q

Tx for syx Lyme

A

Doxy 100 BID x 7-21 days

Can use a single dose of doxy if patient has a tick but no syx

113
Q

skin nodule that is a pearly papule with telangiectasia?

A

Nodular basal cell carcinoma
Most common skin cancer, risk increases with age
Fitz I, II
Rare mets

114
Q

Pt from AZ with intermittent fevers, night sweats, dry cough, weight loss, myalgias x 4 weeks. Dx?

A

Cocciodiomycosis

115
Q

pulmonary fungal infection associated with midwest

A

Histoplasmosis

116
Q

pulmonary fungal infection in medwest, Atlantic, and southeastern states

A

Blastomycosis

117
Q

classic lab finding in post strep GN

A

RBC casts

118
Q

Most useful stat in evaluating effectiveness of a tx?

A

NNT

119
Q

To help with abx stewardship, CDC recommends all pts admitted on an antibiotic empirically to have to time out to review necessity at?

A

48h post admission

120
Q

FABER test produces posterior pain

A

SI joint dysfunction

121
Q

parent asks what could increase a toddlers risk of developing asthma?

A

Exposure to RSV increases risk

exposure to high microbial environment is protective

122
Q

Pt with sinusitis is allergic to PCN. Tx?

A

Doxy

Will likely have run to Augmentin

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