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Fam1Module1 > December > Flashcards

December Flashcards

1
Q

Which are the two most common causes of CAP?

a) S. pneumoniae
b) H. influenzae
c) M. pneumoniae
d) Group A strep
e) M. catarrhalis

A

Choices a) S. pneumoniae and c) M. pneumoniae are the most common causes

Note: H. influenzae is common in smokers

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2
Q

A patient presents with pain, CVA tenderness, nausea, vomiting. What is the likely diagnosis?

a) UTI
b) kidney stone
c) gallbladder inflammation
d) pyelonephritis

A

Answer: d) pyelonephritis (per Hollier 1st choice)

Note: second choice kidney stone; third choice UTI

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3
Q

Osgood-Schlatter Disease is a common cause of knee pain during adolescence due to rapid bone growth. What diagnostics are required?

a) X-ray
b) CT
c) none
d) MRI

A

Answer: c) none (diagnosis can be made based on clinical examination)

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4
Q

Treatment for Osgood-Schlatter Disease might include (choose all that apply):

a) muscle relaxers
b) Tylenol/Ibuprofen
c) ice
d) stretches & strengthening activities for the quadricep

A

Answer: b,c,d (management does NOT include muscle relaxers)

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5
Q

How long does Osgood-Schlatter Disease take to resolve typically?

a) 1 month
b) 6 months
c) 12 months
d) 18 months

A

Answer: c) 12 months

Note: child may continue sports participation as tolerated

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6
Q

What drug can cause rebound headaches in the management of migraines?

a) toradol (ketorolac)
b) Sumatriptan (Imitrex)
c) depakote ER (divalproex sodium)
d) Ergots (dihydroergotamine)

A

Answer: b) sumatriptan (imitrex)

Note: overuse of abortive medications can cause rebound headaches

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7
Q

What is NOT true of triptans?

a) they are safe to use in uncontrolled HTN/heart disease
b) cause vasoconstriction
c) metabolized by liver
d) contraindicated with MAOI use

A

Answer: a) they are safe to use in HTN/ heart disease

triptans are contraindicated in ischemic heart disease, CAD, uncontrolled HTN, PVD, CVD

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8
Q

A patient presents after swimming with: ear pain, normal TM, afebrile. What is the likely diagnosis.

a) otitis externa
b) otitis media

A

Answer: a) otitis externa

“Swimmers ear” occurs due to excessive moisture and causes pain on the external ear, redness/edema in the ear canal, discharge, normal TM, and afebrile.

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9
Q

First line treatment for otitis externa?

a) amoxicillin
b) ofloxacin
c) clindamycin
d) cefdinir

A

Answer: b) ofloxacin drops (if bacterial)

If fungal: clotrimazole drops

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10
Q

Most common bacterial organism for otitis externa?

a) aspergillus
b) streptococcus pneumoniae
c) pseudomonas
d) H. influenzae

A

Answer: c) pseudomonas

Other bacterial causes are: staphylococcus & streptococcus

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11
Q

During the ACCOMPLISH trial for blood pressure control, what combination of drugs was found to be the most effective?

a) HCTZ+ lisinopril
b) metoprolol+chlorthalidone
c) benazepril+amlodipine
d) amlodipine+furosemide

A

Answer: c) benazepril+ amlodipine

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12
Q

Celiac disease is characterized by an autoimmune attack on the small intestine where the individual cannot tolerate gluten. This is is manifested by bloating, n/v/d, abdominal pain, and weight loss. What diagnostics are NOT indicated?

a) serology testing (antibodies)
b) genetic testing (HLA-DQ2 & HLA-DQ8)
c) barium enema
d) endoscopy (biopsy)

A

Answer: c) barium enema is NOT indicated for diagnosis

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13
Q

What type of statin is indicated for each patient listed below:

age <75 with established ASCVD
age >75 with established ASCVD

A

Answer:
o High intensity statin: < 75 y/o
o Moderate intensity statin: > 75 y/o

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14
Q

True or false, a patient with LDL >190 should be on a statin?

A

Yes, high intensity.

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15
Q

What are the lipid ideal levels:

Total:
LDL:
HDL:
Trigs:

A

Answer:

Total cholesterol: less than 200
LDL: less than 100
HDL: 40+ (men) and 45+ (women)
trigs: less than 150

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16
Q

Assign the following patients the appropriate statin:

1) DM age 40-75 ASCVD risk <7.5% w/o other risk factors
2) DM age 40-75 ASCVD risk <7.5% with other risk factors
3) DM age 40-75 ASCVD risk 7.5%

A

Answer:

1)ASCVD risk < 7.5% without other risk factors: Moderate intensity statin
2) ASCVD risk < 7.5% with other risk factors: High intensity statin
3) ASCVD risk > 7.5%: High intensity statin

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17
Q

A 45 year old diabetic patient has an ASCVD risk of <7.5% without other risk factors, what type of statin should he be on?

a)low intensity
b) moderate intensity
c) high intensity

A

answer: moderate intensity statin

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18
Q

ASCVD Risk & statin indication:

1) Risk 7.5% to 20% without other risk factors

2) Risk 7.5% to 20% with other risk factors

3) Risk > 20% with or without risk factors

A

1) Risk 7.5% to 20% without other risk factors: Moderate intensity statin
2) Risk 7.5% to 20% with other risk factors: High intensity statin
3) Risk > 20% with or without risk factors: High intensity statin

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19
Q

What ages do we evaluate ASCVD risk (what is the calculator indicated for in terms of age)?

A

Ages 40-79 on the website (will accept ages 20+ but cannot calculate)

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20
Q

ASCVD risk in a 30 year old is 22%, you should:

a) initiate low intensity statin
b) initiate moderate intensity statin
c) initiate lifestyle changes
d) no treatment required, classification is not accurate until age 40

A

Answer: c) initiate lifestyle therapy first

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21
Q

A patient presents with a boggy/tender/warm prostate, what is the likely diagnosis?

a) prostatitis
b) prostate cancer
c) bleeding internal hemorrhoids
d) gonorrhea

A

Answer: a) prostatitis

Other symptoms: low back pain, urinary frequency/urgency/dysuria/decreased stream, fever, chills, pain with defecation and ejaculation

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22
Q

What is the most common cause of acute prostatitis?

a) enterococci
b) E. coli
c) pseudomonas
d) STIs

A

Answer: b) E. coli (65-80% of all cases)

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23
Q

Treatment options for prostatitis include all of the following EXCEPT:

a) ciprofloxacin (fluoroquinolone)
b) bactrim (sulfa agent)
c) tetracycline (doxycycline)
d) cephalosporins (cefixime)

A

Answer: all of the following are acceptable treatment options

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24
Q

A patient presents with post-void drip as the chief complaint, what is the likely diagnosis?

a) STI
b) BPH
c) prostatitis
d) bladder spasm

A

Answer: b) BPH

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25
Q

A nerve injury involving toe walk is which spinal process/location:

a) L4
b) L4/L5
c) S3
d) S1

A

Answer: toe walk is associated with S1

Note: heel walk (L4/L5); squat (L4); big toe strength (L4/L5)

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26
Q

Patient was on vacation in Bali and has travelers’ diarrhea. What is the most likely organism causing this?

a) shigella
b) salmonella
c) E. coli
d) vibrio cholerae

A

Answer: c) E. coli

Note: campylobacter jejuni (second most common)

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27
Q

What are shin splints?

a) microvascular tears in the tendons between the ankle/knee
b) hairline fractures of the tibia
c) inflammation of muscles/tendons/bone around tibia
d) nerve damage due to elevated glucose as seen in DM

A

Answer: c) inflammation of muscles/tendons/bone around tibia

Typically from repetitive movement, improper foot wear, flat feet. The pain can be sharp or dull and can occur during exercise or at rest.

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28
Q

Which is not a treatment component for shin splints?

a) rest
b) ice
c) compression
d) massage

A

Answer: d) massage

Other treatment options include: NSAIDs, supportive shoes, stretching

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29
Q

How long should a patient with shin splints be pain free for before returning to exercise?

A

2 weeks

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30
Q

Positive straight leg test can show:

A

Disc herniation

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31
Q

What is a description of cluster headache symptoms?

a) band-like squeezing
b) knife to head
c) burning
d) dull pain clustered to one side of the head

A

Answer: b) knife to the head

other symptoms are eye tearing

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32
Q

Which HIV med crosses the blood-brain barrier?

A

NRTI (Zidovudine)

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33
Q

What HIV treatment approach is the most effective for reducing cognitive issues long term?

A

HAART

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34
Q

The ISH committee hypertension guidelines for initiating treatment (what BP)?

A

140/90

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35
Q

JNC 8 Hypertension guidelines:

Age <60 treat BP if:
Age 60+ treat BP if:
If DM treat BP if ______ (despite age)

A

If < 60 y/o treat BP > 140/90
If > 60 y/o treat BP > 150/90
If DM treat BP > 140/90 despite age

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36
Q

What medication class works best to lower isolated systolic hypertension?

A

CCBs or thiazides

37
Q

What is the Somogyi effect?

a) hyperglycemia between 0500-0600 related to an increase in growth hormone at night
b) hypoglycemia at night with rebound hyperglycemia in the morning

A

Answer: b) hypoglycemia at night with rebound hyperglycemia in the morning is called the Somogyi effect

38
Q

The Somogyi effect is best managed by what change in insulin?

a) decrease nighttime insulin
b) increase nighttime insulin

A

Answer: a) decrease nighttime insulin

With Somogyi there is too much PM insulin which causes hypoglycemia, glucagon is released which leads to hyperglycemia in the morning

39
Q

What is the Dawn phenomenon?

a) hyperglycemia between 0500-0600 related to an increase in growth hormone at night
b) hypoglycemia at night with rebound hyperglycemia in the morning

A

Answer: a) hyperglycemia between 0500-0600 related to an increase in growth hormone released at night

40
Q

The Dawn phenomenon is best managed by what change in insulin?

a) decrease nighttime insulin
b) increase nighttime insulin

A

b) increase nighttime insulin

41
Q

Which blood glucose rises first in DM2?

a) pre-prandial
b) post-prandial
c) fasting

A

Answer: b) post-prandial

42
Q

What FEV1/FVC is considered diagnostic for COPD?

A

FEV1/FVC <0.70 is considered diagnostic

43
Q

What are the GOLD classifications for COPD in terms of severity?

1) mild
2) moderate
3) severe
4) very severe

A

1) mild >80%
2) moderate 50-80%
3) severe 30-50%
4) very severe <30%

44
Q

Treatment initiation for COPD is:

a) LABA + ICS
b) LAMA/LABA
c) LAMA+ ICS
d) LAMA or LABA

A

Answer: d) LAMA or LABA is appropriate for treatment initiation

reliever SABA (albuterol)

45
Q

What is track 1 initiation for asthma treatment:

a) SABA as needed
b) daily SABA
c) LAMA+ICS as needed
d) LABA+ ICS as needed

A

Answer:
d) LABA+ICS as needed

step up is: LABA+ICS daily

46
Q

Treatment of asthma as indicated with peak flow <60% should be treated with what?

A

Oral steroids

47
Q

What is the most common composite material for kidney stones?

A

answer: calcium oxalate

48
Q

Appropriate diagnostics for mono (EBV virus), choose all that apply:

a) monospot
b) CBC w/ diff
c) rapid strep
d) U/S for spleen & liver enlargement

A

Answer: all of the above are appropriate

49
Q

What advice is appropriate for a patient diagnosed with mono? Choose all that apply:

a) exercise as tolerated
b) rest
c) tylenol/ibuprofen
d) adequate fluids

A

Answer: b, c, d

Rest, tylenol/ibuprofen, and fluids are indicated.

Patient should NOT have any exercise/sports for minimum of 3 weeks due to risk for spleen rupture

50
Q

Strep throat treatment first line:

a) levofloxacin
b) cephalexin
c) penicillin

A

Answer: c) penicillin (Pen V, Pen G, amoxicillin)

51
Q

What treatment is appropriate for strep throat with a penicillin allergy?

a) amoxicillin
b) macrobid
c) azithromycin

A

Answer: c) azithromycin

other options are cephalexin

52
Q

If a patient has strep and mono what is the treatment?

A

azithromycin

53
Q

In hypothyroidism, what labs are expected:

TSH:
T3/T4:

A

Hypothyroidism:

TSH: high
T3/T4: low

54
Q

In hyperthyroidism, what labs are expected:

TSH:
T3/T4:

A

Hyperthyroidism:

TSH: low
T3/T4: HIGH

55
Q

How is dosage determined for managing hyperthyroidism and medications (what lab)?

a) TSH
b) T3
c) free T3
d) T4
e) free T4

A

Answer: e) free T4

56
Q

What are the ranges for A1C (normal, prediabetic, diabetic)?

A

Normal <5.7%
Prediabetic 5.7-6.4
Diabetic 6.5+

57
Q

Ranges for fasting blood glucose (normal, prediabetic, diabetic)?

A

Normal <100
Prediabetic 100-125
Diabetic 126+

58
Q

What ABI is diagnostic for PAD?

A

ABI <0.90

59
Q

True or false, allergic sinusitis is worsened with exposure to allergen?

A

True

60
Q

Top 3 causes of acute bacterial rhiunosinusitis (URI symptoms which are 10+ days and have a “double sickening”):

A

S. pneumoniae, H. influenzae, M. catarrhalis

61
Q

What is the first line treament for bacterial rhinosinusitis?

a) augmentin
b) clindamycin
c) levofloxacin
d) doxycycline

A

Answer: a) augmentin

62
Q

If a patient is allergic to penicillin but has acute bacterial rhinosinusitis, which treament is NOT appropriate?

a) augmentin
b) doxycycline
c) clindamycin
d) levofloxacin

A

Answer: a) augmentin because it is a penicillin drug

63
Q

When is sinusitis referred?

A

Refactory to antibiotics

64
Q

When is sinusitis referred (choose all)?

a. Refractory to abx
b. Recurrent
c. Bilateral facial/pain
d. Concern for etiology other than chronic sinusitis
e. Periorbital cellulitis

A

Answer: A,B,D,E

Refer if:
a. Refractory to abx
b. Recurrent
d. Concern for etiology other than chronic sinusitis
e. Periorbital cellulitis

If UNILATERAL facial pain

65
Q

A patient presents with a dog bite from 1 hour ago, what are appropriate treatment approaches (choose all that apply)?

a) cleanse with NS
b) search for foreign body
c) suture
d) tetanus shot
e) Augmentin

A

Answer: a,b,d,e

The wound should be cleansed with NS, search for foreign body, tetanus shot given, augmentin provided. Area should NOT be sutured unless on face (time is a critical consideration in this as well-rule of thumb is if anything greater than 6-12 hours do not suture)

66
Q

Common risk factor of PAD (choose all that apply):

a) female gender
b) age <40
c) smoking
d) diabetes

A

Answer: c) smoking and d) diabetes

67
Q

Common cause of ED:

A

Psychological

68
Q

Relationship between statin use and liver “stress”

A

Less than 1% of patients will have an issue

69
Q

Diabetic medications that target PPG (choose all that apply):

a) TZD
b) DPP-4i
c) mealtime insulin
d) SGLT-2i
e) GLP-1

A

Answer: all of the above

Note: SGLT-2i also target fasting blood glucose

70
Q

Diabetic medication class that targets fasting blood glucose?

A

Sglt-2 inhibitiors (Invokana, Farxiga, Jardiance)

71
Q

Your patient is taking metformin and a sulfonylurea (Glimepiride) and is having frequent occurrences of hypoglycemia, you should:

a) decrease dose of metformin
b) decrease dose of sulfonylurea
c) decrease dose of both

A

b) decrease dose of sulfonylurea

72
Q

If a patient was immunized against Hep B, and now immune, what type of test result would they have?

a) anti HBsAg positive
b) anti HBcAg positive
c) HBsAg positive
d) anti HBc IgG

A

Answer: a) anti HBsAg positive

This means the surface is reactive due to the immunization, but not the core.

IgG would indicate a “core” infection that is resolved (if anti-HBs is positive) and chronic if IgG is positive along with HBsAg positive

73
Q

Most common transmission type for hepatitis B?

A

blood, boy fluids, sexual contact

74
Q

Most commmon organism responsible for nosocomial pneumonia?

A

Nosocomial (think hospital acquired)

organism is pseudomonas aeruginosa

75
Q

Asthma FEV/FVC classification in terms of severity:

1) mild intermittent:
2) mild persistent:
3) moderate persistent

A

1) mild intermittent: over 85% of predicted value
2) mild persistent: over 80% of predicted value
3) moderate persistent 75-80% of predicted value

Remember COPD is <0.7 of predicted

76
Q

Track 2 treatment of asthma (not preferred track) for being uncontrolled with SABA use alone should be:

a) take ICS when SABA taken
b) take ICS+LABA as needed
c) take ICS+ LABA daily
d) take ICS+LAMA

A

Answer: a) take ICS when SABA is taken

77
Q

When is a low intensity statin indicated:

a) during pregnancy
b) for a 30 year old patient with an ASCVD risk of 22%
c) if high or moderate intensity statins are not tolerated
d) HDL is 40

A

Answer: c) For patients who cannot tolerate a high or moderate intensity statin

78
Q

First line approach to low back pain:

a) muscle relaxers
b) opioids
c) NSAIDs
d) antidepressants

A

Answer: c) NSAIDs

79
Q

Which medication type does NOT raise blood pressure:

a) sleep meds
b) hormonal birth control
c) NSAIDs
d) SSRIs
e) decongestants

A

Answer:

a) sleep meds

80
Q

24 year old patient has had repeated BP readings of 145/83 (range but close to that) you check it today and it is elevated, you:

a) encourage lifestyle changes and reevaluate in one month
b) suggest a low sodium diet
c) start on metoprolol low dose
d) start on HCTZ

A

Answer: d) start on HCTZ

Note: lifestyle changes should also be implemented, but you cannot wait a month to initiate treatment

81
Q

Patient is consistently having elevated fasting sugars, taking an intermediate insulin (Lantus). What should you do?

a) increase lantus dose
b) start on sulfonylurea
c) start on mealtime fast-acting insulin (Novolog)
d) start on GLP-1 inhibitor

A

Answer: c) start on mealtime fast-acting insulin (Novolog) at the largest meal of the day initially, can increase to other meals if needed

82
Q

Patient has persistent AFIB (AF continues for 7+ days) and is on warfarin, they ask when they can stop, you tell them:

a) once they feel better
b) once their INR is 1.5
c) they will be on it indefinitely
d) now so that you can evaluate whether they are a candidate for cardioversion

A

Answer: c) they will be on it indefinitely

INR goal is 2-3 if nonvalvular Afib;

Other agents are preferred over warfarin unless the patient has valvular Afib

83
Q

Patient takes the prescribed 3 doses of nitroglycerin for angina but the pain persists, they should:

a) take 81 mg aspirin
b) drive to the ER
c) call 911

A

Answer: c) call 911

84
Q

Patient awoke with redness to eyes and mucopurulent drainage, that tells you it is:

a) viral
b) bacterial
c) allergic
d) fungal

A

Answer: b) bacterial

85
Q

A child has valve stenosis, what are the initial steps (choose all that apply)?

a) surgery to open valves
b) valve replacement
c) EKG
d) echo
e) check clotting factors (PT, INR, PTT)

A

Answer: c) EKG & d) echo

86
Q

What is the most common bacteria responsible for UTIs?

A

E. coli

87
Q

Scarlet fever associated heart issues are from what illness commonly?

A

Group A strep

88
Q

First line treatment options for hypertension (choose all that apply):

a)ACE-I
b) beta-blockers
c) calcium channel blockers
d) thiazide diuretics

A

Answer: a) ACE-I, d) thiazide diuretics, c) CCB

89
Q
A

Fam1Module1 (5 decks)

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