board study - intraining Flashcards
During rounds at the nursing home, you are informed that there are two residents on the unit
with laboratory-confirmed influenza. According to CDC guidelines, who should receive
chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
C
an influenza outbreak is defined as two laboratory-confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis for all
asymptomatic residents of the affected unit. Any resident exhibiting symptoms of influenza should be
treated for influenza and not given chemoprophylaxis dosing.
Facility staff of the
affected unit can be considered for chemoprophylaxis if they have not been vaccinated or if they had a
recent vaccination, but chemoprophylaxis is not recommended for all staff in the entire facility.
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has had
two male sex partners in the last 6 months and uses oral contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical motion
and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows only
WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered at the time
of diagnosis and not delayed until the results of the nucleic acid amplification testing (NAAT) for
gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or adnexal tenderness that can
range from mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy. Acute
phase indicators such as fever, leukocytosis, or an elevated C-reactive protein level may be helpful but are
neither sensitive nor specific. A positive NAAT is not required for diagnosis and treatment because an
upper tract infection may be present, or the causative agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infection. Pelvic ultrasonography may be used if there is a concern
about other pathology such as a tubo-ovarian abscess
A 24-year-old patient wants to start the process of transitioning from female to male. He has
been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria.
Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
5.
E
For a female-to-male transgender patient this is most easily accomplished
with testosterone. When testosterone levels are maintained in the normal genetic male range, gonadotropins
and ovarian hormone production is suppressed, which accomplishes both goals for hormonal treatment
without the need for additional gonadotropin suppression from medications such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of a functioning testicle.
Letrozole is an estrogen receptor antagonist, but it would not increase serum testosterone levels.
Spironolactone has androgen receptor blocking effects and would not accomplish either of the hormone
treatment goals.
PAP and HPV at what age?
30
Long-term proton pump inhibitor use is associated with an increased risk for A) Barrett’s esophagus B) gout C) hypertension D) pneumonia E) type 2 diabetes
D
Acid suppression therapy is associated with an increased risk of community-acquired and health
care–associated pneumonia, which is related to gastric overgrowth by gram-negative bacteria. Long-term
treatment of Barrett’s esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI therapy
does not increase the risk of gout, hypertension, or type 2 diabetes.
While inflating the blood pressure cuff on her right arm you observe carpopedal spasms. Which one of the following is the most likely electrolyte disturbance? A) Hypercalcemia B) Hypocalcemia C) Hypokalemia D) Hypernatremia E) Hyponatremia 2
B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves that
control them, is present in up to 94% of patients with hypocalcemia. Hypercalcemia is more likely to
present with hyperreflexia.
24-year old female presents to your office with a 3-month history of difficulty sleeping. She
says that she struggles to fall asleep and wakes up multiple times at night at least three times a
week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies
awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of
the night trying to fall back asleep. Lately she has been feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to return
in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping
an average of 5½ hours per night.
Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an hour if she wakes up at 3:00 a.m.
D
Reducing time in bed increases
sleep efficiency. In this case, 6 hours of time in bed would improve the patient’s sleep efficiency and a
bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is accomplished by
postponing bedtime rather than getting up earlier. Naps generally do not improve sleep efficiency. While
getting out of bed is recommended after being in bed for 30 minutes without falling asleep, or being awake
for 30 minutes after being asleep, staying up for a prescribed period of time is not recommended.
how many weeks do you do abx for face?
try to limit it to 12
does vitamin D and calcium prevent falls in older adults
nope
NYHA class II vs III
I = no limitations II = mild sx with normal activities III = significant limitations in actvitities. Symptoms with less than normal activities - so if they are still doing normal activities, it is a II. IV = rest
if thinking stress fracture and xray is normal… what next
MRI, not bone scint
For the second episode of an abscess, we typically repeat I&D and Word catheter placement.
●For patients who have failed treatment with a Word catheter and now have a third episode, we suggest marsupialization.
.
19. Which one of the following should NOT be consumed during pregnancy due to a potentially high mercury content? A) Catfish B) Crawfish, shrimp, and lobster C) Flounder and haddock D) Salmon and trout E) Shark and swordfish
E
- think large fish that consume other fish.
migraine in pregnancy 32 weeks. Failed apap . A) Dihydroergotamine B) Metoclopramide (Reglan) C) Naproxen D) Oxycodone (OxyContin) E) Sumatriptan (Imitrex)
B
Metoclopramide and acetaminophen are the only two medications considered safe for abortive migraine
treatment during pregnancy (SOR B). The dopamine antagonist antiemetics are considered second-line
abortive treatments in the general population. NSAIDs are
not considered safe during pregnancy, particularly in the first and third trimesters. Opioids are only
moderately useful for migraine treatment and should be avoided during pregnancy due to their abuse
potential. Triptans are generally considered safe during the first trimester but not in the second and third
trimesters. Their use has been associated with uterine atony, increased risk of bleeding during delivery,
and increased risk of preterm birth
Activities of daily living are self-care activities that are performed daily, such as eating, bathing,
dressing, transferring between the bed and a chair, and toileting, including bladder and bowel function.
Instrumental activities of daily living include activities necessary to live independently, such as using a
telephone, doing housework, preparing meals, taking medications properly, and managing finances.
.
The effects of anorexia on the hypothalamic-pituitary axis can cause which one of the following? A) Bone loss B) Elevated testosterone C) Hyperglycemia D) Hypothyroidism E) Menorrhagia
A
***GH helps bone growth. Think of Amy getting the dexa scan.
when to use racemic epi
Croup only
- dex and racemic epi.
(D/RE - Croup)
asthma treatment in the ED
albuterol
steroids
IV mag if needed.
cRoup = Racemic epi asthMa = Mag
Cobb angle of what in a skeletally immature female should be referred
> 29 degrees.
Absolute risk reduction
vs
Relative risk reduction
Prevalence vs incidence
ARR is the arithmetic difference in risk or
outcome rates between the treatment group and the control group. The relative risk reduction indicates how
much the risk or outcome was reduced in the treatment group compared to the control group.
prevalence = # of people found to be affected by a medical condition
incidence = # of new cases.
sarcoid
think eye involvement.
bones are affected more because steroid use
digital mucous cyst -
commonly occur on the dorsal surface of the distal phalanx.
Treatment options include intralesional corticosteroid injections, repeated puncture and
drainage, or surgical excision (SOR A).
corticotropin stim test is for what?
steroid test - helps with adrenal insufficiency - like cushings.
COPD - FEV1
This patient is in his forties without clear risk factors and has both an irreversible obstructive pulmonary
defect consistent with COPD
(FEV1 <80% of predicted and an FEV1/FVC ratio <0.70)
MI in clinic. with O2 sat of 93%. do you use oxygen? and if so, how much?
A) No oxygen therapy B) Oxygen via nasal cannula at 2 L/min C) Oxygen via nasal cannula at 6 L/min D) 100% oxygen with a regular mask E) 100% oxygen with a nonrebreathing mask
A
A 67-year-old female patient began taking a bisphosphonate for treatment of osteoporosis 2 years
ago after a DXA scan revealed a T-score of –2.7. Her FRAX score showed a 10-year probability
of hip fracture of 5%. You order a repeat DXA scan and her T-score is now –2.3 and her FRAX
score is 3.5%.
Which one of the following should you recommend to this patient regarding the duration of
treatment with a bisphosphonate?
A) Stop taking it now
B) Continue taking it for 1 more year
C) Continue taking it for 3 more years
D) Continue taking it for 7 more years
E) Continue taking it indefinitely
C
treatment is indicated for patients at high risk of
fracture, including those with osteoporosis, defined as a T-score of –2.5 or less, or osteopenia, defined
as a T-score of –1 to –2.5 and a 10-year probability of hip fracture of at least 3% using the FRAX tool.
She is still osteopenic
- For patients with atrial fibrillation, which one of the following comorbid conditions represents
the strongest indication for thromboprophylaxis with warfarin (Coumadin), rather than a direct
oral anticoagulant?
A) A CHA2DS2-VASc score 3
B) End-stage chronic kidney disease
C) A mechanical heart valve
C
For patients with atrial fibrillation and end-stage chronic kidney disease, both apixaban (a direct factor Xa
inhibitor) and warfarin are comparable options.
However, warfarin is still recommended
over a DOAC for valvular atrial fibrillation that occurs in the presence of moderate to severe mitral
stenosis or a mechanical heart valve.
48. The most common symptom of alcohol withdrawal in the elderly is A) confusion B) seizures C) tachycardia D) tremor E) vomiting
A
SBO most common cause in a 65 year old that had an appe in the past: A) Constipation B) Intestinal adhesions C) A neoplasm D) Ventral herniation E) Volvulus
B
Intestinal adhesions are the most common cause of small bowel obstruction, accounting for 60%–75% of
cases. Less common causes include neoplasms in 13%–20% of cases, herniation in 2%–15% of cases, and
volvulus in <5% of cases. Severe constipation is a rare cause of small bowel obstruction.
- Which one of the following oral iron preparations is most effective for the treatment of iron
deficiency anemia in a patient with non–dialysis-dependent chronic kidney disease?
A) Ferric citrate (Auryxia)
B) Ferrous fumarate
C) Ferrous gluconate
D) Ferrous sulfate
A
The one exception is ferric citrate, which is highly
efficacious in all patients with chronic kidney disease
Intravenous iron preparations such as iron dextran
are similarly effective in both groups and are considered the gold standard for the treatment of iron
deficiency in patients on chronic hemodialysis
FC and FD - think CKD
Resting tremor think…
Essential tremor think…
resting = parkinsons essential = benign essential tremor
asymptomatic COPD pt based on spirometry - what next?
A) No treatment
B) A long-acting anticholinergic
C) A long-acting -agonist
D) An inhaled corticosteroid
E) Combination therapy with a corticosteroid and long-acting -agonist
There is no evidence from randomized, controlled trials to show that treating asymptomatic individuals,
with or without risk factors for airflow obstruction, prevents future respiratory symptoms or reduces
subsequent declines in lung function.
The DSM-5 criteria for the diagnosis of adult ADHD require symptoms to have been present before age
***
12
Which one of the following has been shown to be most effective in preventing diabetes in
patients such as this?
A) Participation in the National Diabetes Prevention Program
B) Acarbose (Precose)
C) Liraglutide (Victoza)
D) Metformin (Glucophage)
A\
Patients who participate in long-term lifestyle intervention programs such as the CDC’s National Diabetes
Prevention Program have an approximately 30% reduction in progression to type 2 diabetes. Metformin is also effective in reducing the progression to diabetes, but it is not as effective as lifestyle
intervention programs for most patients.
You tell the medical students that evidence suggests that tobacco cessation in pregnant women
A) decreases the risk for cesarean delivery
B) decreases the risk for preeclampsia
C) decreases the need for epidural anesthesia
D) increases infant birth weight
E) increases the risk for preterm delivery
67.
D
Delayed puberty in girls is defined as the absence of breast development by age ___. Typically, menarche
starts 2.5 years after the onset of breast development, with an average age of 12.5 years (normal range
9–15 years). In girls with otherwise normal sexual development, the absence of menarche by ___ years of
age should prompt an evaluation for primary amenorrhea.
13
15
- An elderly homeless male is brought to the emergency department. He is clearly hypothermic
due to cold exposure and has superficial frostbite of his extremities. He is still conscious and
shivering.
In addition to rewarming him, which one of the following should you administer?
A) Acetazolamide (Diamox Sequels)
B) Amitriptyline
C) Ceftriaxone
D) Ibuprofen
E) tPA
D
Continued cold exposure leads to ice crystal formation, which causes cellular lysis, electrolyte
abnormalities, and microvascular occlusion. Rewarming creates an inflammatory response. Ibuprofen is
the most appropriate agent for the treatment of frostbite until the wounds heal or surgery is performed
(SOR C).
Amitriptyline is used to treat the pain of immersion foot (also called trench foot), which is a nonfreezing injury that happens when the foot is exposed to prolonged wet conditions above 0°C (32°F).
tPA has a role in treating patients with frostbite, but it is used only to decrease the
risk of amputation when rewarming patients with grade 3, grade 4, or deep frostbite (SOR B).
t/f Medical testing prior to cataract surgery does not improve outcomes and is not recommended.
True
what is central hypothyroidism?
Central
hypothyroidism is associated with a low TSH level and low T3 and T4 levels.
MSM - how often do they get syphilis screening
annually
adult-onset, severe and persistent, non-atopic asthma and aspirin sensitivity. This
type of asthma is defined as intrinsic asthma and affects approximately 10% of patients with asthma.
Patients with intrinsic asthma commonly also have ***
nasal polyps.
is metformin safe when breastfeeding
yes
can you give entresto if someone has angioedema
no
A 17-year-old male presents to your office to be screened for celiac disease. His older sister was
recently diagnosed with biopsy-confirmed celiac disease. He has had intermittent abdominal
bloating but no other symptoms.
Which one of the following is the current best practice to screen for celiac disease in this
situation?
A) No screening and treatment based on family history
B) Antigliadin antibodies
C) Endomysial antibodies
D) Serum total IgA levels and IgA tTG antibodies
E) Esophagogastroduodenoscopy with small bowel biopsies
D
lots of people are asymptomatic, but given its genetic risks, it is worth checking.
when do we start fluoride supplementation
6 months
Which one of the following medications in her current regimen is most likely to cause an
elevated calcium level?
A) Alendronate (Fosamax) B) Lithium C) Omeprazole (Prilosec) D) Sertraline (Zoloft) E) Spironolactone (Aldactone)
B
Of the options listed, lithium
is the only medication that can cause high calcium levels. In addition, thiazide diuretics, excluding
aldosterone receptor antagonists such as spironolactone, often cause elevated calcium levels.
The inability to use and make sense of numbers is a common problem encountered in
physician-patient communication that can make it difficult to achieve shared decision-making.
Which one of the following methods has been shown to be a helpful strategy when discussing
numbers?
A) Using relative risk instead of absolute risk
B) Using icon arrays (pictographs) to show ratios
C) Using percentages instead of frequencies
D) Framing outcomes in either positive or negative terms, but not both
B
use pictures
A 30-year-old male has moderate to severe rectal pain that occurs with bowel movements and
lasts for several hours. He reports minimal bright red blood on the toilet tissue. On examination
he is noted to have an anal fissure in the posterior midline. Sitz baths and fiber supplementation
have provided no relief, and topical nifedipine therapy did not resolve his symptoms.
Which one of the following would be an effective treatment?
A) beta-Blocker injection
B) Botulinum toxin injection
C) Corticosteroid injection
D) Lidocaine injection
E) Rubber band ligation
B
An anal fissure is a longitudinal tear in the anoderm that occurs most often midline. The initial treatment
is sitz baths and increased fiber intake. If there is no improvement, botulinum toxin is indicated. Topical
nitroglycerin and diltiazem may also be used.
The three cardinal symptoms of aortic stenosis are
angina,
dyspnea,
and presyncope or syncope.
75% of symptomatic patients die within 3 years unless
they receive a valve replacement.
what ist he preffered shingles vaccine
shingrix, NOT zostavax
due to much higher efficacy than the live zoster
vaccine.
what age can the shingrix be given
CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine), separated by 2 to 6 months, to prevent shingles and the complications from the disease.
new diagnosis of GAD - which med? Which one of the following is the first-line long-term treatment for this patient? A) Alprazolam (Xanax) B) Buspirone C) Duloxetine (Cymbalta) D) Imipramine (Tofranil) E) Quetiapine (Seroquel)
C
SSRIs and SNRIs are recommended as first-line
drug therapies because of their tolerability and efficacy compared with other drug therapies.
Buspar is NOT an initial therapy.
Which one of the following would be the best recommendation for a typical back strain?
A) Ice
B) Targeted exercises
C) Oral analgesics
D) Spinal manipulation
E) Evidence does not support the superiority of any modality
E
Recommendations for the treatment of back pain often include ice, targeted exercises, oral analgesics, and
spinal manipulation. Although there is some evidence that certain modalities are better than placebo, there
is very little evidence to show that one modality is superior to another in relieving back pain or shortening
the course of the pain.
T/f No thiazide in Chronic gout it is contraindicated
T
HPV vaccine 2 or 3 doses?
Two doses of HPV vaccine are recommended for children and adolescents who start the series before 15 years
of age. The second dose should be administered 6–12 months after the initial dose.
If the patient is 15 years
or older at vaccine initiation, then a three-dose series would be indicated at 0, 1–2, and 6 months.
A healthy 29-year-old female sees you for a health maintenance visit. You recommend influenza
vaccine but she declines because she has angioedema with ingestion of any eggs or egg products.
She has an epinephrine auto-injector (EpiPen) and last used it approximately 9 months ago when
she accidentally ingested a small amount of egg. She has not seen her allergist in more than 3
years but is planning to call soon for an appointment.
Based on CDC guidelines, which one of the following would you recommend for this patient
regarding influenza vaccination?
A) No influenza vaccination regardless of vaccine form
B) Vaccination only with inactivated influenza vaccine
C) Vaccination with any licensed form of influenza vaccine
D) Referral to an allergist for specific allergen testing prior to vaccination
C
Patients with an egg allergy
can receive any form of the influenza vaccine. Patients who have an angioedema reaction to egg products
should receive the vaccine in an office setting.
What kind of flu vaccine should I get if I have more serious reactions to eating eggs or egg-containing foods like cardiovascular changes or a reaction requiring epinephrine?
If you are someone who has more serious reactions to eating eggs or egg-containing foods, like angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, you can get any licensed flu vaccine (i.e., any form of IIV, LAIV, or RIV) that is otherwise appropriate for your age and health status, but the vaccine should be given in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.
Are there still people with egg allergies who should not get flu vaccine?
People with egg allergy can receive flu vaccines according to the recommendations above. A person who has previously experienced a severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, should not get a flu vaccine again.
NASH with signs of cirrhosis.
Laboratory Findings
Platelets 112,000/mm3 (N 150,000–450,000)
Creatinine 0.8 mg/dL (N 0.6–1.2)
Hemoglobin A1c 6.6%
AST 68 U/L (N 8–48)
ALT 55 U/L (N 7–55)
Albumin 3.2 g/dL (N 3.5–5.0)
Bilirubin 0.5 mg/dL (N 0.1–1.2)
INR 1.0 (N <1.2)
Which one of the following medications should be AVOIDED in this patient to reduce the
likelihood of complications of her medical condition?
A) Acetaminophen
B) Atorvastatin (Lipitor)
C) Ibuprofen
D) Lisinopril (Prinivil, Zestril)
E) Metformin (Glucophage)
C
the diagnosis of cirrhosis
should be confirmed and assessed by methods such as transient elastography,
NSAIDs such as ibuprofen should be avoided in patients with cirrhosis due to the risk of renal insufficiency
(SOR B).
Statins can be safely
used in compensated cirrhosis and may improve steatosis (SOR A)
119. Which one of the following types of hallucinations is associated with Parkinson’s disease? A) Auditory only B) Auditory and visual C) Hypnagogic D) Hypnopompic E) Visual only
E
AH and VH = schizophrenia
others are for sleep
A 23-year-old male presents for evaluation of wrist pain after he fell while skateboarding. On
examination he has left wrist pain with snuffbox tenderness. A radiograph of his wrist shows a
fracture through the midportion of the scaphoid with 2 mm of displacement.
Which one of the following would be the most appropriate treatment of this injury?
A) A thumb spica cast
B) A short arm cast
C) A long arm cast
D) Closed reduction followed by a thumb spica cast
E) Surgical fixation
E
Key - it is displaced… so surgery. No matter how small.
displaced fractures should
be treated with surgical fixation.
***The proximal pole of the scaphoid is entirely dependent on this distal blood supply.
Nondisplaced fractures of the distal third of the scaphoid may be treated
with a short arm thumb spica cast for 4–6 weeks.
Middle and proximal fractures should be treated with a long arm thumb spica cast for 6 weeks, followed by a short arm thumb spica cast.
rotterdam
1) polycysistc ovaries
2) anovulation
3) hyperandrogen
***2 of 3
You are working in an urgent care clinic when a 68-year-old male with chronic hypertension
sees you for refills of his medications. He has been out of his medication for the past month and
could not get an appointment with his primary care physician for refills. His blood pressure is
persistently 190/115 mm Hg, even after he has rested in a quiet room for 30 minutes. His blood
pressure previously had been well controlled. He has a moderate headache but otherwise feels
well. An examination, including a funduscopic examination, is normal.
Which one of the following management options would be most appropriate at this time?
A) Refill his usual medications and arrange for follow-up in 1 week
B) Administer oral labetalol (Trandate) every 30 minutes until his blood pressure is
<180/110 mm Hg
C) Administer oral nifedipine (Procardia) every 30 minutes until his blood pressure is
<180/110 mm Hg
D) Administer sublingual nifedipine every 30 minutes until his blood pressure is <180/110
mm Hg
E) Refer for immediate hospitalization for intravenous antihypertensive treatment
B
This patient has a hypertensive urgency, defined as symptomatic acute severe hypertension without
evidence of acute end-organ injury. Hypertensive urgencies may be managed in the ambulatory setting.
Emergent intravenous treatment at the hospital is not indicated. This patient should be treated with an oral
agent with a fairly rapid onset of action, such as clonidine, labetalol, captopril, or prazosin. Topical
nitroglycerin is also an option. Nifedipine may cause unpredictable blood pressure reduction and should
be avoided. The patient may be discharged to resume his usual medications after his symptoms have
improved and his blood pressure is below 160–180/110 mm Hg, with follow-up within a week
- The U.S. Preventive Services Task Force recommends which one of the following for breast
cancer screening?
A) Annual screening mammography for women ages 40–75
B) Annual screening mammography for women ages 50–75
C) Biennial screening mammography for women ages 35–75
D) Biennial screening mammography for women ages 50–75
E) Biennial screening mammography for women ages 45–50 and annual screening
mammography for women ages 51–75
D
Current U.S. Preventive Services Task Force guidelines for breast cancer screening recommend biennial
screening mammography for women ages 50–75 (B recommendation). Biennial screening mammography
can be considered for women age 40–49 after discussing the risks and benefits with the patient (C
recommendation).
For patients with chronic kidney disease, current evidence shows that a low-salt diet
A) decreases mortality
B) lowers blood pressure
C) increases proteinuria
D) increases the time to end-stage renal disease and the need for dialysis
B
Current evidence is lacking as to whether a low-salt diet leads to decreased
mortality or an increased time to dialysis.
At a routine visit, a 65-year-old male former smoker reports shortness of breath and a cough that
has been worsening slowly over the last 6 months. On examination you hear bibasilar inspiratory
crackles. An EKG, chest radiograph, and echocardiogram are normal. CT of the chest shows
multiple bilateral patchy areas of consolidation.
The most appropriate next step is to
A) take a detailed history of medication use and lifetime environmental exposures
B) start an antibiotic
C) start furosemide (Lasix)
D) start an inhaled short-acting -agonist as needed
E) refer for pulmonary rehabilitation
What is the diagnosis
pulmonary fibrosis - no wheezing, but crackles heard on exam.
A
If initiated today, which one of the following contraceptive methods does NOT require the use
of backup contraception?
A) Oral contraceptives
B) An etonogestrel subdermal implant (Nexplanon)
C) A copper-containing IUD (ParaGard)
D) A levonorgestrel IUD (Mirena)
C
Backup contraception is needed if a
hormonal implant is placed more than 5 days from the start of the last menstrual period, and if a
levonorgestrel IUD is placed more than 7 days from the start of the last menstrual period.
Anti–smooth muscle antibodies are used to confirm **
Anti-centromere antibodies, a subset of ANAs, are more closely associated with ***
autoimmune hepatitis,
systemic sclerosis (centaurs have a sclerosed system)
While serving as team physician at a football game on a hot afternoon you are asked to evaluate
an obese 17-year-old player who has begun limping. The player reports that he is very hot. An
examination is normal except for a gastrocnemius spasm. You diagnose heat cramps. As you
prepare to start treatment with isotonic fluid, stretching, and massage, the coach asks you how
soon the athlete can return to play.
You inform the coach that the player can resume participation
A) now
B) tomorrow
C) upon resolution of his symptoms
D) when his temperature is <38.3°C (100.9°F)
E) after acclimating to the heat for 1 week
C
Just heat cramps doesn’t require much else
Meniscus tear in a heatlhy 45 year old… what should you do?
A systematic review found that arthroscopic procedures for degenerative meniscal tears in middle-aged
adults with little or no arthritis do not significantly improve long-term pain or function compared to
conservative management consisting of physical therapy and a standardized exercise program.
- Which one of the following clinical features is a component of the STOP-Bang questionnaire
used as a screening tool for obstructive sleep apnea?
A) Blood pressure
B) Pulse rate
C) Resting oxygen saturation
D) Smoking status
E) Waist circumference
A
P is for pressure
S = snoring, T = tiredness, O = observed apnea, P = high blood pressure, B =
BMI >35 kg/m2, A = age >50 years, N = neck circumference >40 cm, and G = male gender
should 6 months old with new teeth use a fluoride toothpaste
yes, a low fluoride toothpaste
A 36-year-old male presents with a 6-week history of a mildly pruritic rash in his groin. An
examination reveals small red-brown macules and larger patches with a sharp border. A Wood’s
lamp examination reveals coral-red fluorescence.
Which one of the following would be the most appropriate treatment for this condition?
A) 0.1% triamcinolone cream
B) 2.5% hydrocortisone cream
C) Nystatin cream
D) Erythromycin gel
E) Fluconazole (Diflucan) orally
D
Erythrasma is a superficial infection caused by Corynebacterium minutissimum. It presents as small,
red-brown macules that may coalesce into larger patches with sharp borders. It fluoresces coral red on
Wood’s lamp examination. Cutaneous erythrasma is treated with erythromycin (topical, twice daily until
the rash resolves, or oral, 250 mg four times daily for 2 weeks
Swelling and pain in the retrocalcaneal region
is more characteristic of
retrocalcaneal bursitis.
- The U.S. Preventive Services Task Force recommends vision screening to detect amblyopia
A) at 2 years of age
B) at 3–5 years of age
C) the summer before the child enters first grade
D) once at 4–5 years of age and once at 8–9 years of age
B
The U.S. Preventive Services Task Force recommends vision
screening for all children at least once between 3 and 5 years of age to detect the presence of amblyopia
or its risk factors (B recommendation).
do you get the flu vaccine in pregnancy
YES
if exposed to the flu and not vaccination - when should yo u get the vaccine
now, and still take tamiflu
minimally displaced oblique right fifth proximal phalanx shaft fracture
A) A rigid-sole shoe and weight bearing as tolerated
B) A pneumatic brace and weight bearing as tolerated
C) A short leg walking cast and weight bearing as tolerated
D) A posterior splint and no weight bearing
E) Immediate referral to an orthopedic surgeon and no weight bearing
A
Lesser toe
fractures such as this typically can be managed conservatively with buddy taping and a rigid-sole shoe
Pneumatic brace = think avulsion fracture.
metatarsal shaft fracture = posterior splint then walkign cast. (Bradley)
The goal for treatment should be to lower the systolic and diastolic blood pressures
below the 90th percentile for age, sex, and height. Once children are over 13 years of age, the target
should be a blood pressure ***
<130/80 mm Hg.
Rogain in women
D) Minoxidil (Rogaine) 2% solution for 6 months
E) Minoxidil 5% foam indefinitely
E = regrowth is noticeable around 6 months. d/c leads to loss of regrown hair.
2% solution/5%foam = females
5% solution = males
what is osteochondritis desicans
OCD is defined as osteonecrosis of subchondral bone [1]. Specifically, OCD is a localized lesion in which a segment of subchondral bone and articular cartilage separates from the underlying bone, leaving either a stable or unstable fragment that may result in premature osteoarthritis
OCD most often occurs in the knee, elbow, or ankle of the school-age or adolescent child where it causes pain. Plain radiographs are frequently diagnostic although magnetic resonance imaging (MRI) is typically necessary to further characterize the lesion
should a type I diabetic fast?
Nope
where to adminster epi during anaphylaxis A) Mid-outer aspect of the shoulder B) Mid-outer aspect of the buttocks C) Mid-outer aspect of the thigh D) Mid-outer aspect of the calf E) Lower medial abdominal wall
C
A 43-year-old male with uncomplicated appendicitis prefers antibiotic therapy alone over
surgical treatment. You advise him that this will increase his risk for which one of the following?
A) A longer absence from work
B) The need for pain medications
C) Disability
D) Subsequent surgery
D
Evidence shows that antibiotic therapy alone may be a viable treatment option for patients with
uncomplicated appendicitis. A meta-analysis of five randomized, controlled trials found that antibiotic
treatment resulted in decreased complications, less need for pain medication, and less sick leave or
disability compared with initial appendectomy. However, recurrence rates requiring surgery within a year
may be as high as 40% compared to a less than 10% risk of repeat surgery in those who have an
appendectomy.
do you ever have to I&D a stye
yes if there for longer than 7 days
You see a 60-year-old male for an initial office visit. He has a past history of a myocardial
infarction. He has smoked two packs of cigarettes daily since the age of 18. He says that he
enjoys smoking and has no plans to quit.
Which one of the following would be the most appropriate response?
A) I must advise you that smoking is very bad for your health
B) Did you know that smoking increases your risk of another heart attack?
C) What do you know about smoking’s effect on your health in general?
D) Would it be okay if we discuss smoking?
E) Can I schedule a follow-up appointment soon to focus on quitting smoking?
D
precontempation
do you attempt reduction or get an xray for nursemaids
attempt reduction first
t/f - RSV child there is no clear advantage to deep nasal suctioning, which may also be associated with
prolonged hospital stays. Routine nasal suctioning is indicated, however.
true
Bronchodilators are not
recommended in the treatment of RSV (level of evidence A).
A 6-month-old female is brought to the emergency department by her parents with a 4-day
history of fever, congestion, cough, shortness of breath, and decreased appetite. On examination
of the lungs you note wheezes and crackles throughout. You also note subcostal retractions, an
oxygen saturation of 91% on room air, and a respiratory rate of 42/min. A chest radiograph
reveals peribronchial markings with no infiltrates. The parents say that the patient’s teenage
cousin visited recently and was having “cold symptoms.” You suspect bronchiolitis.
Which one of the following would you recommend next?
A) Maintaining hydration and keeping oxygen saturation >90%
B) Deep nasal suctioning
C) Albuterol via nebulizer
D) Broad-spectrum antibiotics
E) Systemic corticosteroids
A
USPSTF - does it recommend screening for illicit drug use
nope - an I
t/f There is high-quality evidence
(SOR A) that omega-3 fatty acid supplementation has NO effect on cardiovascular disease
true
- A 36-year-old female with no significant past medical history presents to your office following
a syncopal episode. A thorough history and physical examination are normal.
Based on American College of Cardiology/American Heart Association/Heart Rhythm Society
guidelines, which one of the following would you recommend at this time?
A) Reassurance, and follow-up only if she has another syncopal episode
B) A troponin level
C) Electrolyte levels
D) A chest radiograph
E) An EKG
E
the evaluation of patients with syncope should include a thorough history and physical
examination, as well as an EKG. Further studies would be indicated if the cause of syncope is unclear
So A is the wrong answer. Do more testings
Which one of the following is recommended for chronic refractory cough in this otherwise healthy male? A) Cyclobenzaprine B) Duloxetine (Cymbalta) C) Gabapentin (Neurontin) D) Lorazepam (Ativan) E) Propranolol
C
gabapentin has demonstrated benefit for treating a refractory chronic
cough after 4 weeks of treatment (SOR C). Chronic cough may be due to a hypersensitivity of the cough
reflex, either centrally or peripherally. Cyclobenzaprine, duloxetine, lorazepam, and propranolol have not
proven to be beneficial in reducing or eliminating chronic cough.
Ativan can work for nausea though.
keratitis of the eye is what?
inflammation of the CORNEA! think like from contacts etc…
what is episcleritis of the eye?
There is a focal area of hyperemia of the episcleral blood vessels noted along
the medial aspect of the eye. self limited
- A fully immunized 7-month-old male is brought urgently to your office after his parents noted
a possible seizure. The mother says that the infant began to “shake all over” for about 3–4
minutes and then promptly fell asleep for about 20 minutes. When he awoke he was alert but
fussy and crying. He has been ill for the last few days with a cough, congestion, decreased oral
intake, and fevers up to 101°F.
On examination he has an oral temperature of 38.3°C (100.9°F), a heart rate of 170 beats/min,
a respiratory rate of 50/min, and an oxygen saturation of 97% on room air. The infant is fussy
but consolable. His mucous membranes are moist, his tympanic membranes are clear, and he
has a normal oropharynx. He has clear rhinorrhea. Examination of the heart is normal, and
examination of the lungs reveals rhonchi and wheezes. He is moving all of his extremities
normally.
Which one of the following would be the most appropriate initial step in the evaluation of this
child?
A) A basic metabolic panel
B) Radiography of the chest
C) MRI of the brain
D) Electroencephalography
E) A lumbar puncture
Need to find the source of the fever… and he has a respiraotry condition so
B
There is a low risk that
these children will have low sodium or glucose levels, and this would not predict seizure recurrence.
- A 39-year-old female presents to your office for evaluation of a left-sided headache. She notes
pain in the temporal region and inferior to the zygoma. The pain is constant and dull but worsens
with chewing. There is no history of recent trauma. Her past medical history includes
fibromyalgia and her only medication is amitriptyline, 25 mg at bedtime. Her vital signs are
within normal limits and she is afebrile. On examination you note tenderness to palpation over
the temporalis region but no mass or cord. There is no swelling or edema of the head, face, or
neck.
Which one of the following is the most likely diagnosis?
A) Giant cell arteritis
B) A salivary stone
C) Sinusitis
D) Temporomandibular disorder
E) Trigeminal neuralgia
D
TN is much more severe and in huge spasms of pain.
- Which one of the following patients should undergo screening for vitamin D deficiency?
A) A 27-year-old male with recurrent major depressive disorder
B) A 58-year-old male with a glomerular filtration rate of 28 mL/min/1.73 m2
C) A 69-year-old female with chronic osteoarthritis pain
D) A 75-year-old female with recurrent falls
E) An 88-year-old male with severe fatigue
B
The measurement of vitamin D levels is recommended only for patients with decreased kidney function,
various skeletal diseases, or hypercalcemia (SOR C). Vitamin D deficiency is common in patients with
chronic kidney disease, and it is associated with cardiovascular morbidity and mortality in those patients.
CKD - you lose Na and Ca… so low Ca, vitamin D could help raise you Ca… but if you are deficient, that won’t help you.
CURB 65 =
confusion uremia - BUN >19 RR >30 BP <90 or <60 65
