Family Medicine

Question 1

What is the definition of a reactive nonstress test?

Answer 1

2 accelerations within 20 minutes with or without fetal movement detected by the patient.
Preformed in patients who Present with decreased fetal movement

Question 2

what is the definition of a non-reactive nonstress test?

Answer 2

Lack of 2 accelerations over 40 minutes of continuous fetal heart monitoring=> further evaluation needed
Presence of repetitive variable deceleration or deceleration that last for over 1 minute during a NST is considered non-reassuring and often necessitates cesarean delivery.

Question 3

Of the follow drugs switch one decreases potassium levels: albuterol, amlodipine, loser tan, simvastatin, tamsulosin?

Answer 3

Albuterol- increased potassium uptake by the cells.

Other helpful drugs in hyperkalemia states are:
Insulin (give with glucose)
Loop diuretics
Intestinal cation exchange resins
Sodium bicarbonate

Question 4

What is the initial tissue sampling technique of choice for a patient with a raised, superificaial non-pigmented lesion most consistent with non melanoma skin cancer

Answer 4

Shave biopsy- collect the dermal layers necessary for Dx

Punch bx for melanoma

Question 5

What is on the diffdx and what is the next best step?
3 yo F acute onset of fever, sore throat, difficulty swallowing, and muffled speech. Vitals: 103.1 fever, HR 125, RR 30, BP 100/65. Appearance: anxious, leading forward wit ha hyperextended neck. Speaks in muffled voice and drooling. Inspiration strider and tenderness to palpation over her anterior neck.

Answer 5

Epiglottitis- h. Influenzae b infection
Thumb sign on X-ray

Endotracheal intubation
ABC’s

Question 6

Based on the pt present what is her diagnosis and how do you confirm it?
54 yo F cc chest pain and SOB since her husband died 5 days ago. She is health. Meds- low dose aspirin. Vitals 37.1, HR 102, BP 88/60, RR 28, O2 sat. 99%, normal lipids. ECG: T wave inversion in lead V4-V6.

Answer 6

Takotsubo cardiomyopathy=> transient left ventricular dyskinesia, mimics Acute coronary syndrome.
Needs a two-step echocardiogram showing a symptomatic deficit in left wall motion followed by return to physiologic wall motion in 1-4 wks

Question 7

What is the nemonic for depressive symptoms and what does it stand for?

Answer 7

SIGECAPS

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal,

Question 8

A pt has symptoms of DKA. What is the most crucial in the development of the this patient’s disorder?

Answer 8

DM type 1 is autoimmune

FHx of other AI Dx is crucial ex: vitiligo, lupus, Graves, Vasculitis, pernicious anemia, and IBD)

Question 9

31 yo F G1P0 present for 16 wk appointment. She missed her 12 wk and has not had a US. Her serum AFP is 3x normal. Why?

Answer 9

Multiple gestation

Question 10

How can you confirm diabete mellitus?

Answer 10

Fasting glucose of greater than or equal to 126 on two separate occasions
Hgb A1c greater than or equal to 6.5% on two separate occasion
2-hr post oral glucose tolerance test >200
Plus symptoms

Question 11

_____ _____ is the complete disruption of all uterine layers occurring before, during or after childbirth.

Answer 11

Uterine rupture
— a risk factor is Hx is c-section( trail of labor after cesarean delivery), uterine surgery
— new on set pain b/w contractions,vaginal bleeding, and fetal heart rate changes

Question 12

_______ _ ____ ____ ___ block, is due to a disturbance in conduction distal to the AV node, most often within the HIS-purkinje system.

Answer 12

Type 2 Second degrees AV block ( Mobitz II), intermittent non-conducted P-wave without a QRS complex, but PR is consistent

Question 13

What are the tumor marker for germ cell cancer, malignant breast glandular cells cancer, GI tract (pancreatic, gall bladder/biliary duct, gastric cancer), and ovarian cancer, and colorectal cancer?

Answer 13

Germ cell=AFP
Malignant breast glandular cell= Caner antigen 15-3
GI tract= CA19-9
Ovarian= CA125
Colorectal=CEA (carcinoembryonic antigen)

Question 14

What is the different between fibroadenoma of the breast and fibrocystic breast disease?

Answer 14

Fibroadenoma are the MC benign breast neoplasm in women presenting with a solitary, painless, well-circumscribed,rubbery and mobile breast mass. Composed of stroma and epithelial elements and MC found in young W

Fibrocystic breast disease is the MC cause of breast masses in W and presents B/L breast lumps and pain in the upper outer uadrants starting within several days of or prior to menstruation and disappearing after menstruation.

Question 15

What is the A1c goal in elderly patients with a life expectancy of less than 10 years, and with multiple medical comorbidites?

Answer 15

8%

Question 16

What are the recommended vaccinations for pt with AIDs( CD<200)?

Answer 16

Inactivated influenza annually
To/TdaP every 10 yrs
HPV 3 dose series
Pneumococcal polysaccharide or 13-valent conjugate once
Hep B full series

Question 17

What vaccinations are Contraindicated in all HIV pt?

Answer 17

Bacillus anthracis
Small pox
Zoster( shingles) vaccine

Question 18

What vaccinations are contraindicated in pt with a CD4+<200?

Answer 18

Varicella vaccine

Measles, mumps, rubella

Question 19

What is the antibiotic of choice for outpatient prophylactic treatment of uncomplicated animal bite wounds?

Answer 19

Amoxicillin-clavulanate

Beta-lactate plus beta-lactamase inihibitor

Question 20

What is Naegele’s rule?

Answer 20

Estimated due date= for pt with regular 28 day cycles, add 7 days to the first day of their last menstrual period and add 9 months

Question 21

What should all children and adolescents aged 6-17 yo be screened for?

Answer 21

Obesity
— BMI > 95th
—recommendation for children include 60 min/day of moderate aerobic activity( 6-17yo)

Question 22

What are the screening interventions recommended in adolescent populations? (3)

Answer 22

Obesity
Depression
Skin cancer

Question 23

What are the exercise recommendation for adults 18-64yo?

Answer 23

150 minutes per week of moderate aerobic activity
—or 75 min. Per week of vigorous aerobic activity
—anaerobic (weighting-lifting) recommendation 2x

Question 24

What are the MCV, iron, ferritin, and TIBC levels in a pt with anemia of chronic disease?

Answer 24

Low MCV
Low iron
High ferritin
Normal total iron-binding capacity

Question 25

What are Samter’s Triad?

Answer 25

Asthma, nasal poly poses, and aspirin intolerance => aspirin-exacerbated respiratory disease Diagnosis is made with an oral challenge test with aspirin

Question 26

What is the most common EKG finding in patient with a pulmonary embolism?

Answer 26

Sinus tachycardia The more specific PE EKG find is S-waves in lead I, q-waves in lead III, and inverted T-waves in lead III (S1Q3T3), however this is not the MC EKG finding

Question 27

What does an EKG with diffuse ST segment elevation and PR interval depressions without T-wave inversion most likely indicate?

Answer 27

Pericarditis

Question 28

What is the difference between Conduct disorder and oppositional defiant disorder?

Answer 28

Both conduct disorder and ODD features child that are defiant, hostile behaviors towards authority figures present for at least 6 months. Conduct disorders includes violation of the right of others and social Norms and aggressiveness towards animals and people. Setting fires, destroy property

Question 29

How are infants born with meconium present managed?

Answer 29

Expectant management- infants born in the presence of meconium that are vigorous and w/o respiratory distress Nasogastric suctioning: necessary to remove meconium from the stomach after intubation and endotracheal suctioning Intubation and endotracheal suctioning: infants born with meconium present and who are not vigorous at delivery Intubation if HR <60 bpm despite Positive pressure ventilation

Question 30

How do you treat a corneal abrasion?

Answer 30

Discontinuation of contact lens use, disposal of previous lenses, avoidance of eye patching, and the use of an anti-pseudomonas ophthalmic antibiotic (fluoroquinolne or aminoglycosides) Ciprofloxacin- in contact wearers Polymyxin B/trimethoprim eye drop maybe used in non-contact lens wearers with corneal abrasions

Question 31

_______ ______ _____ is the most appropriate next step in diagnosis for patients presenting with Claudication and other sx of peripheral arterial occlusive Dx.

Answer 31

Ankle- Brachial index: a calculation that is performed by dividing the measured systolic BP at the ankle of the affected limb(s) by the systolic BP in the arm. Normal is 0.9-1.1, <0.9 =PAOD After ABI=> angiography

Question 32

What is the appropriate amount of weight gain during a pregnancy for someone with a BMI of 18.5-24.9?

Answer 32

25-35 lbs — decrease risk of c-section, intrauterine growth restriction, and postpartum obesity If the women is obese= 10-20 lbs gain If the women is underweight= 35-45 lbs

Question 33

What do you treat temporal arthritis with?

Answer 33

IV methylprednisolone

Question 34

________ ______ is the most common cause to child intoeing?

Answer 34

``` Internal tibia torsion —MC usually a child 18 mon-3yrs —causing are due to intrauterine positioning, sleeping prone, and sitting of feet —commonly B/L, but if U/L=L — usually resolves by 8 yo ```

Question 35

Describe the prevention protocol for GBS in pregnant women.

Answer 35

—test every women at 35-37 week for GBS —if positive give penicillin (unless delivering via c-sections and dont have ruptured membrane) —In Women w/ unknown status: give prophylaxis if 1.. prolonged rupture of membranes (>18hrs) 2. Intrapartum tempture (.100.4) 3. Immediate delivery to preterm labor (<37 wks) 4. PPROM If 5 wks post sccreening= rescreen If previous baby infected with GBS alway give prophylaxis

Question 36

What screening test are indicated for 20 yo women?

Answer 36

BP and chlamydia

Question 37

Described the recommendation for Chlamydia screening.

Answer 37

All sexually active women aged 24 and younger All pregnant women aged 24 and younger All women aged 25 and older who are at increased risk due to a hx of chlamydia infections, inconsistent condom use, multiple sexual partners, or spouse/partner infidelity

Question 38

What are the screen methods for congenital dislocation of the hip?

Answer 38

Ortolani and Barlow Tests —ortolani= gripping femur, flexing the leg at the hip at 90, and applying posterior pressure toward the acetabulum;+ clunking —Barlow= add addiction Referral to ortho

Question 39

How do you diagnosis a spontaneous bacterial peritonitis (SBP)? (6)

Answer 39

``` Ascites Fever, chills Jaundice abd. Pain Tenderness and fluid wave on PE ``` Dx: paracentesis with fluid analysis that reveals a neutrophil count > 2.5 g/dL Rx: Antibiotic= 3 gen cephalosporin such as cefotaxime or comb treatments w/ aminoglycoside (gentamicin) and ampicillin

Question 40

Which of the following precludes the use of HbA1c for accurate monitoring of glycemic control? Low (6), high (3)

Answer 40

High: —Chronic kidney disease —anemia due to deficiency of vit. B12, folate, or iron —AA, Hispanic, or Asian ``` Low: —SCD —acute blood loss —hemolytic anemia —EPO therapy —Chronic renal failure w/ hemodialysis — B12, iron, folate ```

Question 41

What is CHARGE syndrome?

Answer 41

``` Mutation in the CHD7 gene —Coloboma —Hear anomalies —Cohan always atresia —growth retardation —genital anomalies —ear anomalies HX= intrauterine growth retardation, difficulty feeding die to Chantal atresia, facial clefting, dystrophin features, deafness and FTT ```

Question 42

What are risk factors to considered for new born brachial plexus injuries?

Answer 42

``` Multiparity Large for gestational age Maternal diabetes Previous child w/ it Shoulder dystocia Prolonged second stage of labor ```

Question 43

How do you treat pt presenting w/ moderate to sever asthma exacerbation?

Answer 43

Oral corticosteroids

Question 44

What is the Dx of a baby presenting with grunting and straining while urinating, Failure to thrive and/or urosepsis? How is that Dx confirmed?

Answer 44

Posterior urethral valves Dx w/ voiding cystourethrogram

Question 45

What are the recommendation for AAA screening?

Answer 45

All men receive a 1x screening b/w 65-75 All women receive a 1x screeinging b/w 75-85 If aortic measure b/w 4-5.4cm; rescan in 6-12 mon If aortic measure at 5.5com; elective surgical repair If b/w 3-4 cm F/U in 2-3years

Question 46

What scenarios are the use of antibiotics indicated in acute otitis media?

Answer 46

Patient under 6 mons Patient aged 6 mon-2yrs wi/ sx that are highly suggestive of bacterial otitis media (rapid onset, sign/sx of middle ear inflammation, and signs of middle ear effusion) Pt aged 6mon-2yrs w/ severe illness (fever-102.2) Pt 2 yo w/ sx highly suggestive of bacterial infection and severe illness Pt who will be lost at F/U

Question 47

What should happen to a women who is taken levothyroxine and gets pregnant?

Answer 47

Increase dose of levothyroxine - prevent cretinism (mental retardation, growth restriction, and neuropsychological deficits) - Monitor TSH every 6-8 weeks and every trimester - Initial TSH 5 weeks

Question 48

Describe immune thrombocytopenia purpura.

Answer 48

AI platelet disorder in which antibodies against platelets lead to platelet clearance, resulting in thrombocytopenia -acute: child after a viral infections -chronic: women 20-40 yo Cc: bleeding secondary to thrombocytopenia; petechiae, purpura, mucosal bleeding Rx: corticosteroid, IVIG, IV anti-D

Question 49

How do patient with coal cord dysfunction present?

Answer 49

Vocal cord dysfunction will present w/ non-productive cough, strider, wheezing and dyspnea Differentiated from asthma by spirometry merry, which reveals flattening of the inspiration loop and a normal FVC and FEV1/FVC ratio Abnormal addiction during the inspiration phase of respiration resulting in laryngeal obstruction

Question 50

What is reactive airways dysfunction syndrome?

Answer 50

Pt with no previous respiratory complaints develops an asthma-like pulmonary response after a single, discrete inhalational exposure —inflammatory infiltration of the airway with neutrophils being the predominant inflammatory cells causing edema and epithelial flattening with regeneration

Question 51

What is chorioamnionitis?

Answer 51

It is an intra-amniotic bacterial infections caused by ascending infection within the vagina. Dx: clinically with a combination of maternal fever, tachycardia, uterine tenderness, and fetal tachycardia

Question 52

Von willerand disease is a defect in what?

Answer 52

Clot formation and coagulation cascade