Family Med Flashcards
1
Q
Which patients should be advised to take aspirin, 81 mg daily, for the primary prevention of stroke?
A
Men 45-79 and Women 55-79 who have no history of cardiovascular disease where the benefit of prevention will outweigh the risk of GI hemorrhage
2
Q
Microcytic anemia in child who is otherwise healthy and had recently started whole milk diet?
A
iron deficiency; start oral iron; The patient’s response to a therapeutic trial of iron would be most helpful in establishing the diagnosis.
3
Q
Because of safety concerns, which asthma medication should be used only as additive therapy and not as monotherapy?
A
- long-acting β2-agonists (risk of asthma exacerbation or asthma-related death)
- Inhaled corticosteroids, leukotriene-receptor antagonists, short-acting β2-agonists, and mast-cell stabilizers are approved and accepted for both monotherapy and combination therapy in the management of asthma (SOR A).
4
Q
Preliminary workup for inflammatory bowel disease (IBD)?
A
- WBC count, platelet count, potassium level, and erythrocyte sedimentation rate
- Patients with abnormal lab findings and physical exam findings should have an endoscopy but this is a second step
5
Q
A 3-day-old female developed a rash 1 day ago that has continued to progress and spread. The infant was born at term after an uncomplicated pregnancy and delivery to a healthy mother following excellent prenatal care. The infant was discharged 2 days ago in good health. She does not appear to be irritable or in distress, and she is afebrile and feeding well. On examination, abnormal findings are confined to the skin, including her face, trunk, and proximal extremities, which have macules, papules, and pustules that are all 2–3 mm in diameter. Her palms and soles are spared. A stain of a pustular smear shows numerous eosinophils. Dx?
A
erythema toxicum neonatorum
6
Q
Risk and screening interval for patient with no family history of colon cancer with an 8mm hyperplastic polyp on colonoscopy.
A
- hyperplastic polyps under 10mm are considered low risk
- screening every 10 years.
7
Q
The best drug treatment for symptomatic mitral valve prolapse is:
A
β-blockers (propranolol)
8
Q
Drug used for prevention of altitude illness?
A
- Acetazolamide (CI in pts with sulfa allergy)
- Dexamethasone (safe in pts with sulfa allergy)
9
Q
Most common cause of drug-related interstitial nephritis? treatment?
A
- antibiotics
- Treat with Corticosteroids
10
Q
What has shown to be effective for improving symptoms of varicose veins?
A
Horse chestnut seed extract
11
Q
CI of Breast feeding
A
- in the presence of active maternal tuberculosis
- following administration or use of radioactive isotopes, chemotherapeutic agents,
- “recreational” drugs, or
- certain prescription drugs.
- active herpes simplex lesions on a breast
12
Q
the most common cause of erythema multiforme (type IV sensitivity)
A
Herpes simplex virus (HSV)
13
Q
Diabetes Medication CI in Cardiomyopathy
A
Pioglitazone dut to fluid retention
14
Q
Diabetes Drug CI in Renal Insufficiency
A
Metformin
15
Q
Geriatric Diabetic Treatment
A
Insulin
16
Q
Which one of the following seafood poisonings requires more than just supportive treatment?
A
Scombroid poisoning - tuna, mackerel, wahoo, and bonito
17
Q
greatest risk factor for abdominal aortic aneurysm (AAA)?
A
cigarette smoking
18
Q
Atrial flutter treatment in Hemodynamically stable and in heart failure?
A
- Stable: verapamil and digoxin
- heart failure: electrical cardioversion
19
Q
hypertension treatment in patient with history of stroke?
A
combination therapy with a diuretic and an ACE inhibitor
20
Q
most effective treatment of chronic plaque psoriasis?
A
topical vit D or high-potency corticosteroids (fewer side effects)
21
Q
define astereognosis
A
he ability to recognize objects by palpation in one hand but not the other
22
Q
define Agnosia
A
the inability to recognize previously familiar sensory input, and is a modality-bound deficit. For example, it results in a loss of ability to recognize objects.
23
Q
define Apraxia
A
Even though the patient understands the request, he is unable to perform the task when asked, but may then perform it after a time delay.
24
Q
Treatment for chronic paronychia
A
Topical corticosteroids
25
Most common type of hearing loss in geriatric patients?
presbycusis is the most common cause of hearing loss. Patients typically have the most difficulty hearing higher-frequency sounds such as consonants. Lower-frequency sounds such as vowels are preserved.
26
Which type of colon polyp is most likely to become malignant?
villous adenomas
27
Which one of the following treatments for diabetes mellitus reduces insulin resistance?
Pioglitazone
28
Patient with bloody diarrhea is positive for Escherichia coli O:157. What should you do next?
his patient has a 10%–15% risk of developing hemolytic uremic syndrome secondary to her E. coli O:157 infection, making close monitoring of renal function essential.
29
Therapeutic hemoglobin range for anemic patients
10 - 12g/dL
30
Treatment for child < 29 days admitted for suspected sepsis?
ampicillin and cefotaxime OR ampicillin and Gentamicin
31
Renal Calcium oxalate stone prophylaxis?
- take potassium citrate with meals
- increased fluid intake
- sodium and protein restriction
- Oxalate restriction (spinach, chocolate, tea, and nuts)
32
Ethylene glycol poisoning treatment?
Fomepizole (Antizol)
33
Diabetes medication safe for patients with kidney disease?
Glipizide
34
Treatment for essential (action tremor) when beta blockers cannot be used?
Primidone
35
First-line therapies for urge urinary incontinence?
behavioral therapy, such as pelvic muscle contractions, and anticholinergic therapy
36
Spinal Stenosis vs herniated disk positional pain relief?
Pain from spinal stenosis is relieved by sitting and aggravated by standing, whereas the opposite is true for pain from a herniated disk.
37
initial treatment for ptsd?
Selective serotonin reuptake inhibitors (SSRIs) such as sertraline
38
The diagnosis of giardiasis is suggested by?
foul-smelling, soft, or loose stools; foul-smelling flatus; belching; marked abdominal distention; and the virtual absence of mucus or blood in the stool
39
What condition usually presents with itching and a beefy redness around the anus and/or vulva and will not clear with medications used to treat candidal infections.
group A Streptococcus pyogenes
40
Which cardiac arrhythmia has been reported with high-dose methadone use?
QT prolongation and torsades de pointes
41
treatments most appropriate for a patient with uncomplicated acute bronchitis?
supportive care only
42
The FDA has imposed a black box warning on all thiazolidinediones, such as pioglitazone (Actos). This warning addresses a contraindication to the prescription of these drugs in patients with:
The black box warning for thiazolidinediones specifically addresses heart failure. These agents are also contraindicated in patients with type 1 diabetes mellitus or hepatic disease, and in premenopausal anovulatory women.
43
In breastfeeding women, bilateral nipple pain with and between feedings after initial soreness has resolved is usually due to?
Candida
44
Which antibiotics is most appropriate for treatment of Bartonella henselae infection?
- Azithromycin
| - others = rifampin, ciprofloxacin, trimethoprim/sulfamethoxazole, and gentamicin
45
he best management of localized, well-differentiated prostate cancer in men older than 65 is:
watchful waiting
46
What platelet count is the threshold for prophylactic platelet transfusion in most patients?
10,000/μL
47
Which one of the following medications has the best evidence for preventing hip fracture?
Only zoledronic acid, risedronate, and alendronate have been confirmed in sufficiently powered studies to prevent hip fracture, and these are the anti-osteoporosis drugs of choice.
48
The sensitivity of a test is defined as
the percentage of patients with a disease who have a positive test result.
49
Specificity is
the percentage of patients without the disease who have a negative test result
50
First-line agents for ovulation induction and treatment of infertility in patients with polycystic ovary syndrome (PCOS) include
metformin and clomiphene, alone or in combination, as well as rosiglitazone
51
The FDA issued a boxed warning describing an increased risk of tendinopathy and tendon rupture associated with the use of which class of antibiotics?
Fluoroquinolones
52
When added to compression therapy, which one of the following has been shown to be an effective adjunctive treatment for venous ulcers?
Pentoxifylline
53
A 75-year-old white male suffers an anteroseptal myocardial infarction. Four hours after admission to the hospital his blood pressure is 65/40 mm Hg. A Swan-Ganz catheter is inserted into the pulmonary artery, and the pulmonary capillary wedge pressure is found to be 8 mm Hg.
The best therapy in this instance is:
infusion of normal saline due to low cap wedge pressure (indicates hypovolemia)
54
A 72-year-old male with COPD presents to the emergency department with an acute exacerbation marked by increased sputum production and shortness of breath. His oxygen saturation is 88% on room air and he has diffuse inspiratory and expiratory wheezes bilaterally.
In addition to oxygen and bronchodilators, which one of the following is most appropriate for this patient?
Systemic corticosteroids and antibiotics
55
most concerning early symptom of a dangerous drug reaction?
Pruritus around the mouth and on the palms of the hands and soles of the feet
56
Which one of the following is effective for single-dose prophylaxis against Lyme disease after an Ixodes scapularis tick bite?
Doxycycline
57
pneumococcal vaccine administration guidelines?
- Single dose at 65 for healthy pts
- >50 for chronic disease pts and healthcare workers with a second dose at 65 or 5 years after the initial dose (which ever is later)
58
A 67-year-old female is admitted to the hospital with severe community-acquired pneumonia. Her urine should be tested for which one of the following antigens?
Legionella and pneumococcus
59
A 68-year-old female is being monitored in the hospital after elective surgery. On her third postoperative day she suddenly develops hypoxia, fever, tachycardia, and hypotension. You institute high-rate intravenous fluids and empiric antibiotics. However, approximately 2 hours into this therapy, her blood pressure remains at 80 mm Hg systolic with sluggish urine output.
Which one of the following hormones should be assessed at this time?
Cortisol
60
A young woman in labor at term develops frank eclampsia. What is the best choice of anticonvulsant to treat her condition?
magnesium sulfate
61
Which one of the following is associated with a history of sexual abuse in females?
Lifelong functional gastrointestinal disorders
62
Cardiovascular changes associated with aging include
decreased cardiac output, maximum heart rate, and stroke volume, as well as increased systolic and diastolic blood pressure.
63
Prophylactic migraine treatment under 12 yo
propranolol
64
Which one of the following treatments for type 2 diabetes mellitus often produces significant weight loss?
metformin and incretin
65
Which one of the following has been shown to be helpful with IBS in controlled trials?
Peppermint oil
66
The U.S. Preventive Services Task Force recommends which one of the following regarding general screening for COPD?
No routine screening for COPD with spirometry, chest radiographs, or arterial blood gas analysis, or Peak flow measurement
67
Actinic keratosis is a precursor lesion to:
cutaneous squamous cell carcinoma
68
Which one of the following tests would be best to evaluate this patient for renovascular hypertension?
Duplex Doppler ultrasonography
69
A 2-year-old white male is seen for a well child visit. His mother is concerned because he is not yet able to walk. The routine physical examination, including an orthopedic evaluation, is unremarkable. Speech and other developmental landmarks seem normal for his age.
Ddx? Which one of the following tests would be most appropriate?
- Duchenne muscular dystrophy
| - The disease can be diagnosed earlier by testing for elevated creatine kinase in boys who are slow to walk
70
Treatment: The patient described has symptomatic arterial vascular disease manifested by intermittent claudication
Cilostazol (Pletal)
71
Screening for osteoporosis should be done in which one of the following groups?
All women ≥65 (SOR A) and all men ≥70 (SOR C) should be screened for osteoporosis
72
Treatment of alcoholic ketoacidosis includes
vigorous volume repletion with normal saline, along with administration of thiamine and glucose.
73
recommended as the initial treatment of choice for moderate ascites?
Spironolactone (Aldactone)
74
About a month after returning from the Middle East, an American soldier develops a papule on his forearm that subsequently ulcerates to form a shallow annular lesion with a raised margin. The lesion shows no signs of healing 3 months after it first appeared. He has no systemic symptoms.
The most likely diagnosis is
leishmaniasis
75
Intravenous magnesium is used to correct which one of the following arrhythmias?
ventricular tachycardia of torsades de pointes
76
During rounds, you notice a new rash on a full-term 2-day-old white female. It consists of 1-mm pustules surrounded by a flat area of erythema, and is located on the face, trunk, and upper arms. An examination is otherwise normal, and she does not appear ill.
Which one of the following is the most likely diagnosis?
Erythema toxicum neonatorum
77
insulin infusion with a target glucose level for critically ill patients.
140–180 mg/dL
78
Which one of the following is the recommended duration of dual antiplatelet therapy after placement of a drug-eluting coronary artery stent?
1 year
79
A 21-year-old primigravida at 28 weeks gestation complains of the recent onset of itching. On examination she has no obvious rash. The pruritus started on her palms and soles and spread to the rest of her body. Laboratory evaluation reveals elevated serum bile acids and mildly elevated bilirubin and liver enzymes. ddx?
The most effective treatment for this condition is:
- intrahepatic cholestasis of pregnancy.
| - ursodiol (Actigall)
80
You make a diagnosis of depression in a 26-year-old female. Her BMI is 32 kg/m² and she has been trying to lose weight. Which one of the following antidepressants would be LEAST likely to cause her to gain weight?
Bupropion
81
pharmacologic agents that are beneficial for treating generalized anxiety disorder in adults include
imipramine, duloxetine, paroxetine, sertraline,
| escitalopram, and venlafaxine
82
The most common pathogens in previously untreated acute superficial foot infections in diabetic patients are
erobic gram-positive Staphylococcus aureus and β-hemolytic streptococci (groups A, B, and others)
83
An obese, hypertensive 53-year-old physician suffers a cardiac arrest while making rounds. He is resuscitated after 15 minutes of CPR, but remains comatose.
Which one of the following is associated with the lowest likelihood of neurologic recovery in this situation?
It is difficult to establish a prognosis in a comatose patient after a cardiac arrest. The duration of CPR is not a factor, and the absence of pupillary and corneal reflexes, as well as motor responses to pain, are not reliable predictors before 72 hours. Myoclonic status epilepticus at 24 hours suggests no possibility of a recovery.
84
Supplementation that can help with restless leg syndrome?
iron
85
A 2-month-old female is brought to your office with tachypnea and a staccato cough. She is
afebrile. A chest radiograph shows hyperinflation and bilateral infiltrates, and a CBC reveals
eosinophilia.
Which is the most likely etiologic agent?
Chlamydia trachomatis
86
pruritic, symmetrically distributed papular lesions; violaceous flat-topped papules, usually 3–6 mm in size. ddx? treatment?
- lichen planus
| - Clobetasol (Cormax, Temovate) 0.05% ointment (high potency topical corticosteroids)
87
An elevation of serum methylmalonic acid is both sensitive and specific for a cellular deficiency of which vitamin?
B12
88
Which one of the following treatmens is associated with a herald patch?
Pityriasis rosea
89
A hospitalized patient is being treated with vancomycin for an infection due to methicillin-resistant Staphylococcus aureus (MRSA). Which one of the following is most important to monitor?
Trough serum levels >10
90
Which test reliably excludes adrenal insufficiency?
A single morning serum cortisol level >13µg/dL
91
Which one of the following is necessary to make a diagnosis of polymyalgia rheumatica?
There must be bilateral shoulder or hip stiffness and aching for at least one month in order to make the diagnosis of polymyalgia rheumatica.
92
Which one of the following should be used first for ventricular fibrillation when an initial defibrillation attempt fails?
Epi or Vasopressin
93
Which one of the following is the best radiographic test for confirming the diagnosis of renal colic?
CT
94
Radiographic features of benign lung nodules include
- a diameter <5 mm,
- a smooth border,
- a solid appearance,
- concentric calcification, and
- a doubling time of less than 1 month or more than 1 year.
95
Treatment for Lichen Sclerosis
high-potency topical corticosteroids (fluorinated corticosteroids)
96
Which one of the following is the most accurate imaging study for assessing early osteomyelitis?
MRI
97
The preferred anticoagulant for venous thrombosis during pregnancy is
low molecular weight heparin; Warfarin should not be used during pregnancy but may be used in women who are breastfeeding (SOR B).
98
Which one of the following is most appropriate for the treatment of fibromyalgia syndrome?
heated pool treatment with or without exercise, tramadol for the management of pain, and certain antidepressants,including amitriptyline
99
A chest radiograph of the driver of an automobile involved in a head-on collision shows a widened mediastinum. This suggests:
partial rupture of the thoracic aorta
100
The most common initial symptom of Hodgkin lymphoma is:
painless lymphadenopathy
101
preferred opioids for use in patients with end-stage renal disease
Fentanyl and methadone
102
A patient complains of throbbing bone pain in her lower back and legs. She also has felt weaker recently. Which one of the following tests would confirm a vitamin D deficiency?
25-hydroxyvitamin D
103
antibiotic to be taken prophylactically to prevent bacterial travelers diarrhea.
Rifaximin (Xifaxan)
104
Which one of the following should be given intravenously in the initial treatment of status epilepticus?
Lorazepam
105
Finasteride has considerable efficacy in treating obstructive symptoms, but it unfortunately falsely depresses
PSA levels
