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
