Family

Question 1

What are the two most common causes of decreased vision in elderly patients (especially >75)

Answer 1

1. Cortical cataracts

2. Macular degeneration

Question 2

What are side effects of Ginkgo biloba?

Answer 2

Increased bleeding risk, used for memory enhancement

Question 3

What are side effects of Ginseng

Answer 3

Increased bleeding risk

Question 4

What are side effects of Black cohosh

Answer 4

Hepatic injury, used for postmenopausal sx

Question 5

What are side effects of Kava Kava

Answer 5

Sever liver damage

Question 6

what is dx:
Pt experiences acute onset of flushing, throbbing headache, palpitations, abdominal cramps 30 mins after eating fish at a local restaurant (he has eaten this fish before)

Answer 6

Scombroid poisoning - ingestion of improperly stored seafood (histidine forms histamine)

Question 7

What is the diagnostic test of choice for osteomyelitis?

Answer 7

MRI: sensitivity > 90%, high negative predictive value

Question 8

How what is the gold standard for abx selection of osteomyelitis?

Answer 8

bone bx w culture - superficial wound cultures have little predictive value in identifying the underlying path organisms

Question 9

In a brain dead organ donor, what are 3 factors that threaten organ viability? - What is done to manage this?

Answer 9

1. Central DI - volume depletion
2. Systemic hypotension (loss of sympathetic tone)
3. Hypothermia

Maintain euvolemia w IV fluids and desmopressin, ionotropic/pressor support, Warm air blankets

Question 10

What is the
1. first line
2. second line
therapy for postherpetic neuralgia

Answer 10

1. Tricyclic antidepressants (amitriptyline) - should not be used in older pts or w cognitive impairment
2. Gabapentin, pregab

Question 11

What are recommendations by the American college of cardiology/America Heart Association for patients with diabetes?

Answer 11

Statin therapy for all patients

1. 40-75 with Diabetes
2. LDL >70 mg/dL

Question 12

When should bone density screening begin in women without risk factors?

when should it be earlier?

Answer 12

65

earlier if post menopausal w risk factors:

1. <127lbs
2. chronic steroid use
3. smoking,
4. malabsorptive dz (ie pancreatic insuff in cys fibrosis)
5. parent hx of hip fx, or personal hx of low impact fx

Question 13

When should you screen earlier for colon cancer?

Answer 13

Screen at 40 or 10 before age of relative w Ca
Risk factors:
1. first degree relative <60 w Ca
2. >/= first degree relatives w Ca at any age

Question 14

What is the management of a cat bite?

Answer 14

prophylactic augmentin

Question 15

Which antihypertensive can cause a skin rash?

Answer 15

HCTZ - photosensitivity or dermatitis

Question 16

How should healthcare workings possibly exposed to TB pt be managed?

Answer 16

Workers with a negative TB skin test - retest in 8-10 weeks

Question 17

Which patients is the HPV vaccine indicated for?

Answer 17

All pts 11-26

Question 18

What is dx?
53 yr old with worsening arthralgias, fatigue over the year. palpable liver 1cm below costal margin. fam hx of DM, started 6 months ago on metformin. Arthrocentesis of joint shows positively birefringent rhomboid-shaped crystals

Answer 18

Hereditary Hemochromatosis (bronze diabetes)

• arthropathy + hepatomegaly + fam hx of diabetes
• Calcium pyrophosphate in 50% of pts.

-20fold increase risk of hepatocellular carcinoma

Question 19

How do you manage the pt:

3 yr old with asymptomatic venous lead level 60 ug/dL (normal: <5)

Answer 19

Oral meso-2,3-dimercaptosuccinic acid (DMSA, succimer)

Question 20

How do you manage a pt with lead toxicity (70uq/dL) and or acute encephalopathy

Answer 20

hospitalization
Intramuscular dimercaprol
IV EDTA (calcium disodium edetate)

Question 21

Mgmt?
31 yr old chinese immigrant w abdominal fullness in epigastrum, occasional nausea, no heartburn, dysphagia, early satiety, weighloss

Answer 21

H. pylori testing (dyspepsia = chronic pain/fullness in epigastric area without significant heartburn)

“test and treat” strategy in pt <55
EGD in pts >55