FM Case Files Combined

Question 0

HIV category C

Answer 0

-symptomatic AIDS defining conditions

Question 1

OTC tx of acute diarrhea

Answer 1

• will help slow down the frequency of the stool
• can make certain infections worse bc they prevent your body from getting rid of the organism that is causing the diarrhea

Question 2

Tx for thyroid storm

Answer 2

1. High doses of propothyluracil (PTU)
2. Beta blockers –> to control tachycardia and other peripheral sx
3. Hydrocortisone –> prevent possible adrenal crisis

Question 3

Imaging and serologic testing for primary hypothyroidism

Answer 3

-once dx for primary hypoTH is made and the thyroid is normal on physical exam, no other tests are required

Question 4

4 most common animal bites causing rabies in US?

Answer 4

1. Bats
2. Skunks
3. Dogs
4. Foxes

Question 5

Antibiotics for tx of acute diarrhea

Answer 5

• can help with bacterial diarrhea
• quinolones are usually used (ciprofloxacin) for 1 or 2 days
• -cannot be used in children or pregnant women
• azithromycin as a single dose in adults and for 3 days in children
• -can be used in prego moms
• rifaximin can be used in diarrhea caused by noninvasive strains of e. coli (wont work for fever or blood in stool)

Question 6

Thyroid storm

Answer 6

• acute hypermetabolic state associated w/ sudden release of lg amnts of thyroid hormone into circulation
• causes autonomic instability and CNS dysfunction
• can cause altered mental status, coma, or seizures + fever, restlessness, or psychoticlike behavior
• high mortality risk! MEDICAL EMERGENCY!

Question 7

Chronic diarrhea

Answer 7

-present for more than 4 wks

Question 8

What are the most common bacterial causes of conjunctivitis?

Answer 8

1. Staph
2. Strep
3. H. Influenzae
4. Morexella
5. Pseudo

Question 9

Causes of illness after eating a mayo containing salad w/in 6 hrs, 8-12 hrs, or w/in 12-14 hrs

Answer 9

• < 6 hrs = s. aureus
• 8-12 hrs = c. Perfringens
• 12-14 hrs = e. coli

Question 10

Anosognosia

Answer 10

-no awareness of disability

Question 11

Tx of HTN with strokes

Answer 11

• unless a hypertensive encephalopathy, aortic dissection, acute renal failure, or PE is present, tx of HTN should be cautious!
• give anti-HTN meds when systolic BP is > 220 or diastolic is > 120
• if anti-thrombolitics will be given, then decrease pts systolic P to < 185 and diastolic to < 110
• most commonly used:
  1. Labetalol
  2. Nicardipine
  3. Sodium nitroprusside

Question 12

Ssx of traveler’s diarrhea

Answer 12

1. > 3 loose stools in 24 hrs
2. Abdominal cramping
3. Nausea
4. Vomiting
5. Fever
6. Tenesmus
   * *usually occurs within first 2 wks of travel

Question 13

Aspirin and strokes

Answer 13

• most pts w/ non-hemorrhagic stroke should receive aspirin w/in first 48hrs
• EXCEPT when anti-thrombolytics are given

Question 14

What is usually the cause of prehepatic jaundice?

Answer 14

• hemolysis of RBCs
• they overwhelm the liver’s ability to conjugate and clear the bilirubin through its normal pthwys
• causes hyperbilirubinemia of unconjugated bilirubin

Question 15

Bacterial Conjunctivitis: tx

Answer 15

• can be self-limiting in 10-14 days

- give a sulfonamide instilled locally 3x daily to clear the infection in 2-3 days

Question 16

Causes of hepatic hyperbilirubinemia

Answer 16

• causes either conjugated or unconjugated hyperbilirubinemia
• viruses and alcohol decrease the liver’s ability to transport bilirubin AFTER it has been conjugated, so get conjugated hyperbilirubinemia

Question 17

P. jiroveci pnuemonia: ssx?

Answer 17

1. Nonproductive cough
2. Fever
3. Dyspnea that worsens over few days to few weeks
4. Tachypenia
5. Hypoxic
6. Bilateral infiltrates seen on CXR w/ “ground glass” appearance

Question 18

Tx for diarrhea caused by c. diff?

Answer 18

1. Metronidazole

2. Vancomycin

Question 19

Work up for pt that presents with stroke sx?

Answer 19

1. CT scan WITHOUT contrast –> look for hemorrhage, tumor, abcess
2. Glucose level
3. Drug screen
4. Coagulation studies
5. Serum electrolytes
6. Renal function tests
7. Lipid profile
8. CBC
9. Ekg

Question 20

What is the tx of choice for graves dz?

Answer 20

• radioactive iodine

- as long as the pt is not pregnant, breastfeeding, or a child

Question 21

Hepatitis A: ssx? Incubation period? Transmission period? How long does the illness last? Tx?

Answer 21

• ssx: jaundice, fever, malaise, abdominal discomfort
• incubation period: 2-8 wks
• transmission: possible for 2-3 weeks after symptoms begin
• lasts: 4-6 wks (buts can last up to 6 mnths)
• tx: supportive

Question 22

Contraindications to TPA

Answer 22

1. Stroke occurred > 3 hrs ago
2. Recent surgery
3. Trauma
4. GI bleeding
5. MI
6. Use of certain anticoag meds
7. Uncontrolled HTN

Question 23

What does anti-HBcAg IgM mean?

Answer 23

-acute hep B infection

Question 24

What are the 3 laboratory categories of HIV pts?

Answer 24

1. CD4 cell count of 500 or more 2. CD4 cell count of 200-499 3. CD4 cell count of < 200 cells

Question 25

Which antibiotics can cause c. diff?

Answer 25

- classically associated w/ clindamycin, but ANY antibiotic can cause pseudomembranous colitis - most common: 1. Clinda 2. Cephalosporins 3. Penicillins

Question 26

Risk factors for breast cancer

Answer 26

1. Having first child after age 30 2. Family hx of breast cancer 3. Personal hx of breast cancer or atypical hyperplasia found on previous breast bx 4. Known carrier of BRCA-1 or BRCA-2

Question 27

Recommendations for mammographies for general population?

Answer 27

-start at age 40 (or some sources say 50) and screen every 1-2 yrs

Question 28

Causes of posthepatic jaundice

Answer 28

- usually caused by obstruction to the flow of bile through the bile ducts - can be caused by stones, strictures, or tumors - get a conjugated hyperbilirubinemia

Question 29

What disease puts children at risk for a stroke?

Answer 29

-sickle cell anemia

Question 30

What is the definitive tx of hyperthyroidism? What in a sfx? Who is it contraindicated in?

Answer 30

- radioactive iodine --> destroys thyroid gland - 40% of pts will become hypothyroid & will need thyroid hormone replacement - contraindicated in pregnant women, bc fetus thyroid can take it up and it will destroy their thyroid too --> creatinism

Question 31

What are 3 medications that can be used to tx hyperthyroidism? MOA? Sfx?

Answer 31

1. Propylthiouracil --> preferred in pregnancy 2. Methimazole 3. Carbimazole - MOA: inhibit the organification of iodine - sfx: most serious = agranulocytosis

Question 32

AIDS

Answer 32

- advanced stage of HIV infection | - opportunistic infections are required for the dx

Question 33

5 species common in human bites?

Answer 33

1. Staphylococci 2. Streptococci 3. Haemophilus species 4. Eikenella species 5. Anaerobes

Question 34

Tx of graves dz in adolescents?

Answer 34

-use antithyroid drugs bc Grave's may go into spontaneous remission for them after 6-18 mnths

Question 35

How many postmenopausal women will have an osteoporosis related fracture in their lifetime?

Answer 35

-HALF!!

Question 36

Residual ischemic neurological deficit (RIND)

Answer 36

-a neurologic deficit of greater than 24 hrs and less than 3 wks

Question 37

When are grass pollens typically present?

Answer 37

- late spring through early fall | - but can be present year-round in warner weather too

Question 38

What should be done when a thyroid nodule is found?

Answer 38

-further work-up bc 5-6% of identified nodules are malignant

Question 39

HIV category B

Answer 39

-have symptomatic conditions that are either indicative of a defect in cell-mediated immunity or that are complicated by HIV infections (NOT AIDS defining infections!)

Question 40

3 Sx of oral decongestants

Answer 40

1. Tachy 2. Trenors 3. Insomnia

Question 41

"Alarm features" of GI sx

Answer 41

1. Fever 2. Anemia 3. Involuntary weight loss of > 10 lbs 4. Hematochezia 5. Melena 6. Refractory or bloody diarrhea 7. Family hx of colon cancer of inflammatory bowel dz * *these usually point to an underlying organic etiology & may warrant further workup

Question 42

HIV dx

Answer 42

- standard screening test = ELISA | - positive ELISAs must be confirmed with Western Blot to rule out false positives

Question 43

HIV clinical category A

Answer 43

- asymptomatic - primary infection and generalized lymphadenopathy - persistent generalized lymphadenopathy = enlarged lymph nodes that involve at least 2 noncontiguous sites other than inguinal nodes

Question 44

What is measured in the direct bilirubin?

Answer 44

-the conjugated bilirubin

Question 45

What are the calcium and vit D recommendations for women > 50 yrs

Answer 45

- 1200mg calcium | - 400-800 IU of vit D per day

Question 46

Prophylaxis for P. jiroveci?

Answer 46

-TMP/SMX in HIV pts with CD4 count < 200 cells/microL

Question 47

Tx for diarrhea-predominant IBS

Answer 47

- Loperamide | - reduces frequency of loose stools and urgency

Question 48

In what ots are thyroid nodules more likely to be malignant in?

Answer 48

1. children 2. adults younger than 30 3. adults older than 60 4. pts with hx of head or neck irradiation

Question 49

Decongestants: MOA? Use? Most common one used?

Answer 49

- can be taken orally or intranasally - constrict the blood vessels of the nasal mucosa and reduce the overall volume of the mucosa - pseudophedrine is the most commonly used

Question 50

Tx of animal bites

Answer 50

1. Clean wound with soap and water 2. Irrigate the wound with saline 3. Debridement 4. Tetanus vaccine if needed 5. Contact animal control about rabies 6. 5-7 days of antibiotic prophylaxis (amoxicillin-clavulanate = augmentin), or longer if cellulitis is present 7. Hospitalization or surgery might be necessary if severe!

Question 51

Diarrhea from undercooked hamburger

Answer 51

-enterohemorrhagic E. coli

Question 52

Tx for constipation-predominant IBS

Answer 52

-increase giber intake, via diet or supplement

Question 53

Hep B vaccine recommendations

Answer 53

- universally for all children | - adults at high risk

Question 54

Transient ischemic attack

Answer 54

-a focal neurologic deficit lasting less than 24 hrs

Question 55

Mycobacterium avium prophylaxis

Answer 55

- should be initiated in HIV pts if their CD4 count falls to less than 75 cells/microL - azithromycin

Question 56

What are the 3 most common causes of hyperthyroidism?

Answer 56

1. Graves disease 2. Autonomous nodule that secretes thyroxine 3. Thyroiditis (usually early stage)

Question 57

When should you begin screening women for lipid disorders?

Answer 57

-age 45

Question 58

Poststroke cerebral edema tx

Answer 58

- mannitol | - decompression surgery

Question 59

How to remove a stinger

Answer 59

- remove ASAP - better to scrape or brush the stinger off the skin, rather than grasp it bc grasping it at the base can compress the venom-containing sac and causes increased venom release - BUT its better to rapidly remove the stinger than to spend time looking around for something to scrape the stinger out with (ex credit card)

Question 60

Delayed rxns to insect stings?

Answer 60

- large local rxns mediated by immunoglobulins (IgE) that are reactive to the venom - lg (> 10 cm in diameter) area of redness and warmth--> often confused with cellulitis - develops 24-48 hrs later - tx: oral steroids - tetanus prophylaxis should be done! * * a person with a lg delayed rxn to a sting is more likely to have another one in the future, but this does not change their risk or anaphylaxis

Question 61

Risk factors for animal bites becoming infected?

Answer 61

1. Larger 2. Deeper 3. Hand wounds 4. Presence of chronic illness or immune suppression 5. Cat & humans > dogs to become infectious

Question 62

Diarrhea from mayo

Answer 62

1. Staph aureus | 2. Salmonella

Question 63

Describe the abdominal pain commonly seen with fibromyalgia

Answer 63

- usually in the lower abdomen, esp in the left lower quadrant - cramping pain of intermittent frequency and variable intensity - pain often improves or is relieved with defication - pain will NOT wake a person up from sleep

Question 64

Osteoporosis screening recommendations

Answer 64

-women > 65 & > 60 in higher risk women

Question 65

Which bilirubin is excreted in the urine? What does a high level mean?

Answer 65

- conjugated | - high urine level = conjugated hyperbilirubinemia

Question 66

Tx of abdominal pain with IBS?

Answer 66

1. Antispasmodics --> dicyclomine and hyoscyamine as needed | 2. Low-dose tricyclic antidepressants --> when pain is frequent and severe

Question 67

Which bilirubin can be high in Gilbert's syndrome?

Answer 67

-unconjugated

Question 68

Allergic shiners

Answer 68

-dark circles around the eyes related to vasodilation or nasal congestion

Question 69

Desensitization tx

Answer 69

- used in pts who remain symptomatic despite mac medical tx - steps: 1. Test to figure out specific antigens 2. Inject pt with highly diluted antigen 3. Inject weekly or bi-weekly while gradually increasing the concentration of the antigen

Question 70

In what 2 groups of women apis cervical cancer seen in?

Answer 70

1. Women not screened in over 5 yrs | 2. Women who had an abnormal pap and did not follow-up on it

Question 71

What is the most common cause of diarrhea? Tx?

Answer 71

- viral | - tx: rehydration, antibiotics WONT help!

Question 72

3 most common causes of hypothyroidism?

Answer 72

1. Hashimoto thyroiditis 2. Post-Graves dz thyroid ablation and surgical removal of thyroid gland 3. Secondary hypoTH related to hypothalamic or pituitary dysfunction

Question 73

Antibiotic prophylaxis for traveler's diarrhea

Answer 73

- not indicated unless the pt is at incased risk for complications from diarrhea or dehydration (ex inflammatory bowel dz, renal dz, or immunocomp) - fluoroquinolones are used

Question 74

Most common cause of chronic liver dz in the US?

Answer 74

-hepatitis C

Question 75

3 causes of diarrhea in daycare settings?

Answer 75

1. Shigella 2. Giardia 3. Rotavirus

Question 76

Hep B and hepatocellular carcinoma

Answer 76

-hep B causes 80% of the hepatocellular carcinoma cases worldwide

Question 77

Diarrhea from raw seafood

Answer 77

1. Vibrio 2. Salmonella 3. Hep A

Question 78

Lubiprstone: MOA? Use? Sfx?

Answer 78

- MOA: activates intestinal chloride channels and increases fluid secretion - use: for IBS in women with constipation - sfx: nausea

Question 79

What is the LDL goal for a pt that had a stroke?

Answer 79

-less than 100

Question 80

Antihistamines: MOA

Answer 80

-competitively antagonize the receptors for histamine, which is released from the mast cells

Question 81

Tx for pts with IBS and depression or anxiety?

Answer 81

-SSRIs

Question 82

Acute diarrhea

Answer 82

-present for less than 2 wks

Question 83

Risk factors for cervical cancer (4)?

Answer 83

1. Early onset of sexual intercourse 2. Multiple sex partners 3. HPV infections 4. Tobacco use

Question 84

Leukotriene inhibitors: use?

Answer 84

- indicated for both allergic rhinitis and maintenance tx for persistent asthma - especially useful in pts with both asthma and allergies or in pts whose asthma is triggered by allergies

Question 85

Diarrhea from undercooked chicken

Answer 85

-salmonella or shigella

Question 86

Nephritic

Answer 86

-hematuria

Question 87

Common cause of diarrhea in campers

Answer 87

-giardia

Question 88

What is the most common bacteria involved in human bites that cause a closed fist injury?

Answer 88

-eikenella species

Question 89

Tx of acute Hep B v. Chronic Hep B? Acute --> chronic?

Answer 89

- acute = supportive - chronic = antiviral tx - the younger the pt = the more likely an acute infection is to become chronic

Question 90

Subacute diarrhea

Answer 90

-present for 2-4 wks

Question 91

Noninfectious causes of conjunctivitis: tx

Answer 91

-oral antihistamines or topical antihistamines or anti-inflammatory eye drops

Question 92

Tx of anaphylaxis

Answer 92

1. injection of aqueous epi 1:1,000 in a dose of 0.2 to 0.5 mL (0.2-0.5 mg) --> given subcutaneously or IM ASAP, can be repeated in 10-15min if needed 2. Fluid replacement --> lots of fluid moves into interstitial space 3. Antihistamines --> if severe 4. Steroids --> if severe 5. Bronchodilators --> if severe * *should be observed in hospital for 12-24 hrs bc sx can reoccur!!

Question 93

Risk factors for a stroke?

Answer 93

1. HTN --> most important! 2. DM 3. Age 4. Male sex 5. Family hx 6. Dyslipidemia 7. Smoking 8. Certain CV conditions --> a fib, MI, endocarditis, carotid stenosis, rheumatic heart dz, presence of mechanical valve, advanced dilated cardiomyopathy, patent foramen ovale or AsD

Question 94

Hymenoptera

Answer 94

- order of insects that cause the most insect stings - includes: 1. Wasps 2. Yellow-jackets 3. Hornets 4. Honeybees 5. Bumblebees 6. Fire ants

Question 95

4 Most common causes of conjunctivitis?

Answer 95

1. bacterial 2. viral 3. allergy 4. chemical irritants

Question 96

How is screening for osteoporosis done?

Answer 96

- with a DXA scan = dual-energy x-ray absorptiometry - this is the best predictor of a hip fracture - measurement is compared to that of young adults --> result reported as a T score - osteoporosis = at or below 2.5 SD less than than that of the young adults - osteopenia = at or below 1.0-2.5 SD less

Question 97

IBS dx

Answer 97

- in absence of structural or biochemical explanation (or "alarm features") of sx and the Rome Criteria a pt can be dx - avoid expensive and unnecessary tests when possible - a CBC and stool Hemoccult test should be done! - a colonoscopy should be done in any pt > 50 yrs old!

Question 98

Nephrotic

Answer 98

-proteinuria

Question 99

What is the most common cause of epidemic keratoconjunctivitis? Tx?

Answer 99

- adenovirus - highly contagious - tx: 1. sulfonamide tx to prevent secondary infections 2. Hot compress to reduce discomfort 3. Weak topical steroids to tx corneal infiltrates - usually lasts 2 wks

Question 100

Once HIV is dx, what should be done before tx?

Answer 100

- report to local health authorities --> partner notification laws vary by state - HIV genotype testing --> to ID strains that may be resistant to tx - determine HIV RNA levels to help assess the disease activity - measure CD4 lymphocyte counts - CBC, metabolic panel, & urinalysis - screening for other STDs - PPD

Question 101

Ssx of vertebrobasilar strokes?

Answer 101

1. Motor or sensory loss of ALL 4 limbs 2. Crossed signs 3. Disconjugate gaze 4. Nystagmus 5. Dysarthria 6. Dysphagia

Question 102

Local rxns of insect stings: ssx? When do they occur? Tx?

Answer 102

- ssx: redness, swelling, pain, & itching - occur almost immediately, last for a few hrs - caused by histamine release in response to the venom - tx: ice and anti-histamine ps for itching - also give TETANUS prophylaxis

Question 103

What can happen with chronic use of nasal decongestants?

Answer 103

-rebound hyperemia and worsening of sx

Question 104

When is ragweed present?

Answer 104

-late summer and early fall

Question 105

Diarrhea in travler's to Mexico

Answer 105

-caused by enterotoxigenic E. coli

Question 106

What can be the cause of diarrhea if the stool was found to have leukocytes present in it?

Answer 106

1. Salmonella 2. Shigella 3. Yersinia 4. E. colic 5. C. Diff 6. Campylobacter 7. Entamoeba histolytica

Question 107

4 Common bacteria involved in cat and dog bites?

Answer 107

1. Staphylococci 2. Streptococci 3. Anaerobic species 4. Pasturella species

Question 108

Status asthmaticus

Answer 108

-an airway obstruction that lasts for days or weeks and is refractory to tx

Question 109

Dx of diarrhea?

Answer 109

- most patients dont need work up bc disease is self limiting - exceptions: 1. Fever > 100.4 *F 2. Bloody diarrhea 3. Severe abdominal pain 4. Profuse diarrhea 5. Dehydration 6. > 48 hrs 7. Kids, elderly, Immunoincomp pts

Question 110

Perfect use effectiveness (w/contraceptives)

Answer 110

-efficacy of a method when always used correctly, consistent and reliable use occur

Question 111

When should follow-up visits for pregnancy take place?

Answer 111

- first every 4 weeks until 28 weeks - then every 2 weeks until 36 weeks - then every week from 36 wks til birth

Question 112

Acral lentiginous melanoma: where is it commonly found? Who is it most common in?

Answer 112

- most common melanoma in African Americans and Asians | - commonly found under nails, on the soles of feet, and on palms of the hands

Question 113

Trichomonas: ssx?

Answer 113

- copious amnts of thin, frothy, green-yellow or grey malidorous vaginal discharge - vaginal soreness or dyspareunia - sx start, or are exacerbated during the time of their menses - cervix will be "strawberry red" - motile trichomonads seen on wet prep

Question 114

Postpartum depression: what is it? Ssx? Tx?

Answer 114

- sx are the same as major depression - occur within 4 wks postpartum and can be seen up to 1 year later - severity can range from mild to sever and suicidal - high rate of recurrence in subsequent pregnancies - SSRIs = first line tx

Question 115

Vertical transmission

Answer 115

-infectious passage of infection from mom to fetus whether in utero, during labor and delivery, or post partum

Question 116

Strategy to enhance motivation to quit smoking (5 Rs)?

Answer 116

1. Discuss specific Relevance to quit smoking 2. Risks of ongoing use 3. Rewards to quitting 4. Roadblocks to quitting 5. Repetition = bring it up at each visit

Question 117

How many times a week should short-acting beta-agonists be used?

Answer 117

-no more than 2 times a week, or the asthma is considered to be poorly controlled

Question 118

What does the triple screen test for?

Answer 118

1. hCG 2. Unconjugated estriol 3. Alpha-fetoprotein

Question 119

Uterine atony

Answer 119

- most common cause of postpartum hemorrhage - failure of the uterus to contract adequately - results in continued bleeding from the uterine vasculature - risks: 1. Prolonged labor 2. Prolonged use of oxytocin during labor 3. Large baby 4. Grand multipara (5 or more previous children)

Question 120

Dosage of nicotine nasal sprays?

Answer 120

- each spray provides 0.5mg of nicotine | - should start by using 1-2 sprays per hour with maximum of 40 doses per day

Question 121

Most common cause of pharyngitis?

Answer 121

-viral

Question 122

When do most women resume sexual activity after giving birth?

Answer 122

-by 3 mnths postpartum

Question 123

Isoimmunization

Answer 123

- development of specific antibodies as a result of antigenic stimulation by material from the rbcs of another individual - ex w/ Rh positive fetus and Rh negative moms

Question 124

What baseline heart rate is considered normal for a fetus during delievry?

Answer 124

- 110-160 bpm - less than 110 = bradycardia - greater than 160 = tachycardia

Question 125

When can a child stop using a booster seat in the car?

Answer 125

-when they are tall enough to sit with their back to the seat and their legs bent at the knees over the front of the seat (usually 4'9" and btwn ages 8-12).

Question 126

What does actinic keratosis raise the risk for?

Answer 126

-squamous cell carcinomas

Question 127

Sx of alcohol withdrawal (7)?

Answer 127

1. Tremulousness 2. Insomnia 3. Anxiety 4. Depressed mood 5. GI upset 6. Heart palpitations 7. Sweating

Question 128

RERA

Answer 128

-respiratory effort-related arousals

Question 129

Lochia

Answer 129

- yellow-white discharge, consisting of blood cells, decidual cells, and fibrinous products - usually occurs for 3-6 weeks following delivery

Question 130

Failure rate of Rhythm method?

Answer 130

-14-47%

Question 131

Common sx of acute bronchitis (10)?

Answer 131

1. cough with purulent sputum production --> MOST COMMON 2. Fever 3. Malaise 4. Rhinorrhea or nasal congestion 5. Sore throat 6. Wheezing 7. Dyspnea 8. Chest pain 9. Myaligias 10. Arthralgias

Question 132

4 Signs that can confirm the rupture of membranes ("water broke")?

Answer 132

1. Visualization of amniotic fluid leaking from the cervix 2. Presence of pooling of amniotic fluid in the posterior vaginal fornix 3. pH above 6.5 in fluid collected from the vagina (usually vaginal secretions have a pH less than 5.5), using Nitrazine paper, or visualization of "ferning" on a sample of fluid on an air-dried microscope slide

Question 133

What meds can reduce the effectiveness of OCPs?

Answer 133

1. Some antibiotics 2. Barbiturates 3. Antifungal medications

Question 134

What is considered a long QT interval?

Answer 134

- > 470 msec in men - > 480 msec in women - ANY pt with an interval > 500 msec is at increased risk for dangerous dysrhythmias!

Question 135

Possible complications of OM?

Answer 135

1. Mastoiditis 2. Bacterial meningitis 3. Brain abscess 4. Subdural empyema

Question 136

Tx of choice for pneumonia in a healthy pt?

Answer 136

- macrolide (clarithromycin or azithromycin) | - doxycycline

Question 137

What should be checked in an eye exam of every newborn?

Answer 137

- red reflexes | - can mean congenital cataracts or retinoblastoma

Question 138

What are 2 common side effects of narcotics?

Answer 138

1. Constipation | 2. Sedation

Question 139

What finding on a physical exam is most suggestive of obstructive sleep apnea?

Answer 139

-obesity

Question 140

Common ssx of mitral valve prolapse?

Answer 140

1. Palpitations 2. Fatigue 3. Chest discomfort 4. Dyspnea

Question 141

Active phase of labor

Answer 141

- part of the first stage of labor - starts at 3-4cm of cervical dilation, rate of cervical dilation is at its maximum - contractions are strong and regular

Question 142

Early deceleration

Answer 142

- coincides with a contraction, fetal heart rate declines and then returns to the baseline - thought to be the result of increased vagal tone caused by compression of the fetal head by the contractions --> not associated with fetal hypoxia or acidemia

Question 143

What are 4 features of benign skin lesions?

Answer 143

1. < 6 mm 2. Symmetric 3. Uniform in color 4. Well-defined borders

Question 144

Depo-provera: what is it? How long does it last? Sfx?

Answer 144

- injectable form of progestin = medroxyprogesterone - lasts for 14 wks, injected every 3 mnths - sfx: irregular menses, weight gain, facial/body hair growth * *most women develop amenorrhea after a year of use

Question 145

4 Steps in management of CHF?

Answer 145

1. Supplemental oxygen w/ checking ABCs 2. Loop diuretic - furosemide is drug of choice 3. Nitrates = to reduce oxygen demand, by reducing preload and afterload 4. Morphine = venodilator, arterial dilator, and analgesic effects

Question 146

What are the 4 cardinal movements of the fetal head as it descends through the birth canal?

Answer 146

1. Flexion = fetal chin to the chest 2. Internal rotation = fetal occiput moves anteriorly toward the maternal symphysis pubis 3. Extension = as the head approaches the vulva 4. External rotation = to face either the maternal right or left side

Question 147

Pregnancy category C

Answer 147

-animal studies have shown adverse fetal effects and there are no adequate studies in humans OR no animal studies have been conducted and there are not adequate studies in humans

Question 148

Alcohol dependence

Answer 148

-mental and physical need to consume alcohol in order to prevent the pains of withdrawl and obtain certain results, and associated with in increasing consumption to obtain the same effect

Question 149

Neonatal benefits of breast-feeding

Answer 149

1. Ideal nutrition 2. Increased resistance to infection 3. Reduced risk of GI difficulties

Question 150

Smoking during pregnancy can cause (5)?

Answer 150

1. Prematurity 2. Interuterine growth restriction 3. Stillbirth 4. Spontaneous abortion 5. Infant death

Question 151

Strabiusmus

Answer 151

-ocular misalignment

Question 152

What are the 2 nonnicotine medications that can be used for smoking cessation?

Answer 152

1. Bupropion = zyban | 2. Varenicline = chantix

Question 153

3 most common causes of acute bacterial sinusitis in children?

Answer 153

1. S. pneumoniae 2. H. Influenzae 3. Morzxella catarrhalis

Question 154

When should a 12-lead EKG be done on a pt presenting with palpitations?

Answer 154

- always!! | - even if they are symptom free at the time of the exam

Question 155

Trichomonas: tx?

Answer 155

- oral metronidazole to BOTH partners | * * also make sure to screen for other STDs

Question 156

Tx for pt with v-tachy who is stable? Unstable? Allergic to iodine?

Answer 156

- stable = amioderone - unstable = electrically cardioverted - allergic to iodine = lidocaine

Question 157

What is the onset of action, time to peak, and how long do short-acting beta-agonists last?

Answer 157

- onset in 5 min or less - peak in 30-60 min - last 4-6 hrs

Question 158

What do "minipills" contain?

Answer 158

-only progestrin

Question 159

What labs are recommended at initial prenatal visit?

Answer 159

1. CBC 2. Hep B surface antigen 3. HIV testing 4. Syphyllis screening 5. Urinalysis 6. Urine culture 7. Rubella antibody 8. Blood type and Rh status w/antibody screen 9. Pap smear 10. Cervical swab for gonorrhea and chlamydia

Question 160

What is the failure rate for the minipill? For combination OCPs?

Answer 160

- minipill = 1-3% | - combination = 1-2%

Question 161

What does Atypical pneumonia usually look like on xray?

Answer 161

-bilateral, diffuse infiltrates (rather than focal)

Question 162

Gonorrhea: tx?

Answer 162

- ceftriaxone IM | - empiric tx should be considered in areas of high prevalence of infection or when follow-up is unlikely

Question 163

Risk factors for endometrial carcinoma

Answer 163

1. Hx of anovulatiry menstrual cycles 2. Obesity 3. Nuliparity 4. > age 35 5. Use of tamoxifen or unopposed exogenous estrogen

Question 164

What test should be done if a pheo is suspected?

Answer 164

-24 hr urine collection for catecholamines and metanephrines

Question 165

What are the two long-acting beta agonists? When are they used?

Answer 165

1. Salmeterol = serevent 2. Formoterol = foradil - act for more than 12 hrs - can be used with SABAs * *should NEVER be used as monotx - consider increasing dose of ICS before adding a LABA - increase in sever exacerbations and deaths with use of LABAs

Question 166

Dosing for nicotine gum?

Answer 166

- 2mg pieces for pts who smoke less than 25 cigarettes a day | - 4mg pieces for pts who smoke more than 25 cigarettes a day

Question 167

6 Common causes of menorrhagia:

Answer 167

- bc the bleeding is regular it means that ovulation is occur and that the endocrine pthwys are intact 1. Leiomyomata = fibroids (common cause) --> cause an increased endometrial surface area = increased menstrual bleeding 2. Endometrial polyps (similar mechanism to ^^) 3. Coagulopathy --> most commonly von Willebrands 4. Medications --> ex warfarin 5. Liver dz 6. Thrombocytopenia

Question 168

Bupropion: MOA

Answer 168

-blocks uptake of norepi and/or dopamine

Question 169

What are the 6 etiologies of palpitations (in order of most to least common)?

Answer 169

1. Primary rhythm disturbance 2. Underlying mental health problem - anxiety or panic disorder 3. No identifiable cause 4. Drugs/meds 5. Noncardiac cause 6. Intrinsic structural problem with heart

Question 170

How does pneumonia caused by pneumocystis jiroveci usually look on xray? Who commonly gets this kind of pneumonia?

Answer 170

- bilateral, "ground glass" appearing infiltrate | - commonly seen in AIDS pts

Question 171

What is the leading cause of death in children < 1 yr old? What can be done to reduce these risks?

Answer 171

- SIDS | - risk reducers: "back to sleep", sleeping on a firm mattress, nothing else in the crib

Question 172

Apnea hypopnea index (AHI)

Answer 172

-number of apneas and hypopneas per hour of sleep

Question 173

Tx of substance-induced depression?

Answer 173

- antidepressant meds can be ineffective and even harmful | - refer to substance abuse tx first and then reassess depression 1 month postabstinence

Question 174

Cyst

Answer 174

-closed saclike, membranous capsule containing a liquid or semisolid material

Question 175

What is the most prognostic factor in melanoma?

Answer 175

- the thickness of the tumor | - less than 1-mm thick = low rate of metastasis

Question 176

Legg-Calve-perthes (LCP) disease: what is it? Who is it seen in? Ssx? Dx? Tx?

Answer 176

- avascular necrosis of the femoral head - typically seen in kids age 4-8 - boys > girls - etiology of the disruption of blood flow is unknown - ssx: gradual onset of hip, thigh, or knee pain, and limping over a few months - dx: xray may appear normal at first, then see collapsed, flattened, and widened femoral head - tx: conservative, protect the joint and maintain ROM

Question 177

Contraindications to breast feeding?

Answer 177

1. HIV infection bc of vertical transmission 2. Acute & active hep B (chronic hep B & C can breastfeed) 3. Previous Breast-reduction surgery with nipple transplantation

Question 178

When shoukd emergency treatment for asthma be considered?

Answer 178

1. Peak flow < 40% of the predicted normal 2. Failure to respond to beta agonist 3. Severe wheezing or coughing 4. Extreme anxiety due to breathlessness 5. Gasping for air, sweaty, cyanotic 6. Rapid deterioration over a few hours 7. Severe retractions and nasal flaring 8. Hunched forward

Question 179

What are standard drink measurements for: beer? Wine? Shot?

Answer 179

- beer = 12 oz - wine = 5 oz - shot = 1.5 oz

Question 180

Transient synovitis

Answer 180

- self- limited inflammatory response that often follows a viral infection - common cause of hip pain in children - occurs typically in kids ages 3-10 - boys > girls - sx: gradually increasing hip pain that results in a limp or refusal to walk, low grade fever or no fever, normal WBC count, and normal ESR * * if not better in a few days, consider septic joint

Question 181

OCP use in non-breastfeeding women?

Answer 181

- wait 3 weeks postpartum, risk of thromboembolic dz if start earlier - use combines OCPs

Question 182

When and how should women be tested for gestational DM? What is considered positive? What should be done with a pt that tests positive?

Answer 182

- at 24-28 weeks - w/ 1hr 50g glucose challenge test, a value >135 mg is abnormal, >200 mg is diagnostic - positive 1hr --> do fasting 3 hr challenge test

Question 183

2 most common antibiotics used for acute sinusitis?

Answer 183

1. Amoxicillin 2. Trimethroprim-sulfamethoxazole * *usually 10-14 day prescriptions

Question 184

Contraindications to ACEi?

Answer 184

1. Pregnancy 2. Hypotension 3. Hyperkalemia 4. Bilateral renal artery stenosis

Question 185

Intermittent asthma

Answer 185

- symptoms of asthma that occur less than 2 times a week - nocturnal awakenings that occur less than 2 times a month - need for oral corticosteroids less than 2 times a year - no limitations in normal activities - spirometry is normal btwn exacerbations

Question 186

Monoamine oxidate inhibitors: MOA

Answer 186

-increase the amnts of serotonin and norepi to be released during nerve stimulation

Question 187

What lab tests should be done to rule out noncardiac causes of palpitations?

Answer 187

1. CBC 2. Chemistry panel 4. TSH

Question 188

How many rads until a fetus is at risk from radiation exposure?

Answer 188

-greater than 5 rads

Question 189

What is an acceleration in the fetal heart rate? What can it be in response to? What does it mean?

Answer 189

- increase in the fetal heart rate of 15 bpm or more for 15 sec or longer - this is a reassuring finding - can occur spontaneously or in response to a contraction - ensures that the fetal arterial pH is greater than 7.2

Question 190

What is the most common mechanism that triggers pneumonia?

Answer 190

-upper airway colonization by pathogenic organisms that are aspirated

Question 191

Which 2 newborn screening tests are required by ALL states?

Answer 191

1. PKU | 2. Congenital hypothyroidism

Question 192

Bacterial vaginosis: definition

Answer 192

-excessive anaerobic bacteria in the vagina that leads to a discharge that is alkaline

Question 193

Severe sx of chronic alcohol use withdrawal?

Answer 193

1. Tonic-clonic seizures w/in 6-48 hrs 2. Hallucinations w/in 12-48 hrs 3. Delerium tremens w/in 48-72 hrs

Question 194

Sore throat with rhinorrhea and cough is most likely to be?

Answer 194

-more likely to be viral

Question 195

What are the 3 short-acting beta-agonists that are used for tx of asthma?

Answer 195

1. Albuterol 2. Levalbuterol = xopenex 3. Pirbuterol = maxair

Question 196

Plaque

Answer 196

-a small plateaulike, raised, solid area on the skin that covers a large surface area in relation to its height above the skin

Question 197

What position do children with a septic hip joint usually assume?

Answer 197

-laying with their hip flexed, abducted, and externally rotated

Question 198

Diaphragm: use? Failure rate?

Answer 198

- use: flexible rubber disk that is inserted to cover the cervix, must use spermicide too, & must be properly fitted by a dr - must be left in for at least 6hrs after intercourse - failure: 6-18%

Question 199

What are the top 2 leading causes of death in children over the age of 1?

Answer 199

1. Accidents | 2. Injuries

Question 200

In which asthmatic patients can anticholinergic bronchodilators be used?

Answer 200

- such as ipratroprium = atrovent - can be used in combination with a SABA for tx of severe asthmatic attacks or those induced by beta blockers in the urgent care setting

Question 201

GAS causes what percentage of pharyngitis in adults? Kids?

Answer 201

- 15% in adults | - 30% in kids

Question 202

Chlamydia: tx?

Answer 202

- doxycycline orally for a week or one dose of azithromycin orally when compliance is a concern - empiric tx should be considered in areas of high prevalence of infection or when follow-up is unlikely - tx other partner too!

Question 203

Macule

Answer 203

-discoloration on the skin that is neither raised nor depressed

Question 204

What is the gold standard for dx of GAS pharyngitis infections?

Answer 204

- throat cultures - they take 24-48 hrs * * can do rapid antigen test in the office, it has high specificity, but low sensitivity

Question 205

SCFE: tx? Prognosis?

Answer 205

- tx:surgical w/ pinning | - prognosis: follow closely bc 1/3 develop avascular necrosis and 1/3 develop SCFE on contralateral side

Question 206

Nodule

Answer 206

-small mass of rounded or irregular shape that is greater than. 1.0 cm in diameter

Question 207

How can beta-blockers be used for palpitations?

Answer 207

- they can be used for sx that are short lived or episodic | - act as short-acting negative chronotrophs

Question 208

Labor: when does it usually occur? What is preterm? What is posterm?

Answer 208

- labor begins spontaneously and occurs normally within 2 wks of the estimated date of confinement (= 280 days after the first day of the last menstrual period) - preterm = onset of labor more than 3 wks before the estimated date of confinement (EDC) - postterm = labor that does not spontaneously start by 2 weeks after the EDC

Question 209

What sx does legionella commonly cause with pneumonia?

Answer 209

-diarrhea

Question 210

What is the gold standard for pneumonia diagnosis?

Answer 210

-infiltrated on chest xray

Question 211

What is the most important risk factor for the development of skin cancer?

Answer 211

-exposure to UV radiation

Question 212

Trisomy screen: when is the optimal time? When can the screen be done?

Answer 212

- optimal = 16-18 weeks gestation | - can be done = 15-20 wks

Question 213

Otitis externa tx?

Answer 213

1. Irrigation 2. Topical antibiotics 3. Steroids

Question 214

Which polio vaccination is used today?

Answer 214

-inactivated, injected vaccine (rather than the oral one)

Question 215

Can vaccines be given to a child with a minor illness? With a low-grade fever?

Answer 215

- yes and yes! | - so acute illness visits can be used to update immunizations too!

Question 216

Failure to thrive

Answer 216

- weight below the third or fifth percentile for age - OR decelerations of growth that have crossed 2 major growth percentiles in a short period of time - significant loss or gain of weight should be investigated

Question 217

Dosage of nicotine cartridge inhalers?

Answer 217

- one cartridge has 4mg of nicotine in 80 inhalations | - recommended dose is 6-16 cartridges per day

Question 218

What should routinely be addressed at well-child visits?

Answer 218

1. Injury prevention 2. Nutrition 3. Development 4. Discipline 5. Exercise 6. Mental health issues 7. Need for ongoing care - ex vaccines, etc.

Question 219

How long does breast feeding provide natural contraception?

Answer 219

- 6 mnths postpartum | - after 6 mnths menses restarts & alternative contraception is needed

Question 220

Dysthymic disorder

Answer 220

-chronic depression of mood which does not meet the criteria for major depression, in terms of either severity or duration of individual episodes, yet the patient still has loss of interest, lack of appetite or pleasure, and low energy

Question 221

Palpitations association with what are pathologic?

Answer 221

- palpitations associated with syncope | - consider hospitalizations

Question 222

Which types of condoms are effective against preventing STDs?

Answer 222

-of the 3 types (latex, rubber, or natural skin) ONLY latex condoms are highly effective in preventing STDs

Question 223

When is the MMR vaccination recommended?

Answer 223

-at 12-15mnths and 4-6 yrs

Question 224

Pregnancy category B

Answer 224

-animal studies have shown no harm to fetus, but human studies are not available OR animal studies have shown harm to fetus, but studies in pregnant women have not shown harm

Question 225

Long QT syndrome: ssx?

Answer 225

- palpitations and/or syncope | - have family hx of syncope or sudden death

Question 226

Papule

Answer 226

-small circumscribed ELEVATED lesion of the skin that is less than 0.5cm in diameter

Question 227

What are two leukotriene receptor antagonists? When are they used?

Answer 227

1. Montelukast = singulair 2. Zafirlukast = accolate - use in ots who are unwilling or unable to use inhaled corticosteroids - can be used in mild persistent asthma - indicated in exercise-induced asthma * *tx of choice for aspirin-sensitive asthma!

Question 228

Otitis media: causes (3)?

Answer 228

- caused by upper respiratory tract pathogens, promoted by obstruction to drainage via swelling of congestion of eustachian tubes 1. S. pneumo 2. H. Influenzae 3. M. Catarrhalis

Question 229

What pregnancy category are buproprion and varenicline?

Answer 229

-C

Question 230

Second stage of labor: what is it? How long does it last in a nulliparous and parous woman?

Answer 230

- from complete cervical dilation (10 cm) through the delivery of the fetus - normally lasts less than 2 hrs in a nulliparous woman and less than 1 hr in a parous patient

Question 231

Valvovaginal candidiasis: ssx?

Answer 231

- present with thick, whitish discharge that has no odor - significant puritus of the external and internal genitalia - vaginal area is edematous and erythema is often present - discharge pH is 4.0-5.0 - pseudohyphae or budding yeast are seen on KOH prep

Question 232

Respiratory disturbance index (RDI)

Answer 232

-number of apneas, hypopneas, and respiratory effort-related arousals (RERAs) per hour of sleep

Question 233

Complications of pneumonia (3)?

Answer 233

1. Bacteremia 2. Pleural effusions 3. Empyema

Question 234

Maternal benefits of breast feeding?

Answer 234

1. More rapid return of uterine tone w/ reduced bleeding and a quicker return nonpregnant size 2. More rapid return to pre-pregnancy body weight 3. Reduced incidence of ovarian and breast cancer 4. Connivence of always having food supply 5. Lower cost

Question 235

What are 3 reasons to get a chest x-ray on a pt that is acutely ill with a cough?

Answer 235

1. Dullness to percussion 2. History of fever 3. Clinical suspicion

Question 236

Emergency contraception

Answer 236

- if combined high dose oral contraceptives are taken within 72hrs of unprotected intercourse, risk of pregnancy is 74% * *only RU-486 is effective after 72 hrs!

Question 237

Sx of bacterial rhinosinusitis?

Answer 237

1. 7 days of sx in adults and 10 days of sx in children 2. Purulent nasal discharge 3. Maxillary tooth or facial pain 4. Unilateral maxillary sinus tenderness 5. Worsening of sx after initial improvement

Question 238

What are the 3 "Ps" in the progress of labor?

Answer 238

1. Power = strength of contractions and mom's pushing, contraction strength can be measured 2. Passenger = fetus, its size, lie, presentation, and position in the birth canal 3. Pelvis = shape and size of the pelvis can result in a delay or failure of descent of the fetus bc of the relative disproportion btwn the fetal and pelvic size

Question 239

What is the first line tx in pts w/ CHF and reduced left ventricular function?

Answer 239

- ACEi = reduce preload, reduce afterload, improve CO, and inhibit-RAS - reduce sx & mortality

Question 240

Common complications of breast feeding?

Answer 240

1. Sore or cracked nipples 2. Mastitis = obstruction of milk glands, sometimes secondarily infected w/ bacteria - tx = continues feeding or pumping + oral antibiotics (cephalexin or dicloxacillin) --> dont discontinue nursing!!

Question 241

Fetal lie

Answer 241

- the relationship of the long axis of the fetus to the long axis of the mother - either longitudinal or transverse

Question 242

What are the 5 As?

Answer 242

1. Ask 2. Advise - tell pt about their specific risks 3. Assess 4. Assist 5. Arrange - follow-up and support

Question 243

Vesicle

Answer 243

-small blister less than 0.5 cm

Question 244

Late deceleration

Answer 244

- gradual reduction in the fetal heart rate that starts at or after the peak of contraction and has a gradual return to the baseline - the result of uteroplacental insufficiency - can be caused by: 1. Maternal hypotension = (most common) can be caused by epidural and oxytocin use 2. Conditions that impair placental circulation = maternal hypertension, DM, prolonged pregnancy, placental abruption

Question 245

Which drugs/meds can cause palpitations?

Answer 245

1. Alcohol 2. Caffeine 3. Street drugs (esp cocaine) 4. Tobacco 5. Decongestants --> often in otc and herbal weight loss drugs 6. Diuretics --> cause electrolyte disturbances 7. Digoxin 8. Beta agonists (ex albuterol) 9. Theophylline

Question 246

Pregnancy category D

Answer 246

-human studies have shown potential adverse fetal effects, however the benefits of therapy outweight the potential risks

Question 247

Nedocromil: MOA? Use? Sfx?

Answer 247

- stabilizes the mast cells and interferes with chloride channel fctn - can be used for tx of mild persistent asthma - have few side effects, but must be used multiple times per day

Question 248

Tx of insulin resistance in PCOS?

Answer 248

-metformin and thiazolidinediones

Question 249

Superficial spreading melanoma: what is it? How does it grow? Common sites?

Answer 249

- most common type of melanoma in both men and women - spreads superficially along the top layers of skin before penetrating into deep layers - superficial spreading is slower than the vertical spreading --> can invade dermis and metastasize - men more commonly affected on upper toso - women are more commonly affected on legs

Question 250

When is the varicella vaccination recommended?

Answer 250

-ages 12-15 mnths and 4-6 yrs

Question 251

What should be done before a cardioversion and why?

Answer 251

- TEE | - to look for thrombus that might dislodge with cardioversion

Question 252

4 Ts of postpartum hemorrhage (causes)?

Answer 252

1. Tone = uterine atony 2. Trauma = cervical, vaginal, or perineal lacerations; uterine inversion 3. Tissue = retained placenta or membranes 4. Thrombin = coagulopathies

Question 253

Metrorrhagia

Answer 253

-bleeding that occurs at irregular intervals

Question 254

What is considered "moderate" drinking?

Answer 254

- men = 2 or less drinks per day - women = 1 or less drinks per day - over 65yrs = less than one drink per day

Question 255

IUD: sfx?

Answer 255

- short term sfx, esp at time of insertion 1. Bleeding 2. Cramps 3. Backache 4. Dizziness 5. Longer/heavier periods at first

Question 256

Symptoms of depression (9)?

Answer 256

- dx need at least 5 out of the 9, and they must occur during the same 2-week time period 1. Depressed mood 2. Diminished interest or pleasure 3. Significant weight loss or weight gain 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Feeling of worthlessness 8. Diminished ability to think or concentrate; indecisiveness 9. Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan

Question 257

Intravaginal ring contraceptive: what is it? Use? Sfx?

Answer 257

- NuvaRing = flexible transparent ring that delivers etonogestrel and ethinyl estradiol - woman inserts the ring herself and wears it for 3 weeks, removes it and discards it - week off = withdrawal bleeding + insertion of new ring - sfx = similar to OCPs

Question 258

Vulvovaginal candidiasis: tx?

Answer 258

- short-term intravaginal preparations | - or single dose oral therapies of fluconazole

Question 259

Mucopurulent cervicitis: characterizations

Answer 259

- characterized by purulent or mucopurulent discharge from the endocervix - can be associated with vaginal discharge and/or cervical bleeding

Question 260

Tricyclic antidepressants: MOA

Answer 260

-affect the reuptake of both norepi and serotonin

Question 261

When do l | Early postpartum hemorrhages occur? Late?

Answer 261

- early = within 24hrs | - late = btwn 24hrs and 6 wks after delivery

Question 262

When should a child be drinking whole cows milk?

Answer 262

- whole milk from age 12mnths-2yrs old | - then switch to reduced fat milk

Question 263

Abscess

Answer 263

-closed pocket containing pus

Question 264

Yuzpe method?

Answer 264

- method of emergency contraception | - take combined OCPs

Question 265

Failure rates of male condoms?

Answer 265

-15%, which is usually due to improper use

Question 266

Ulcer

Answer 266

-lesion through the skin or mucous membrane resulting from loss of tissue

Question 267

What is the most common cause of ventricular arrhythmias?

Answer 267

-ischemia

Question 268

MAOi: sfx

Answer 268

- serotonin syndrome w/ hypertensive crisis, need to be on reduced tyramine-diet to avoid this, can be fatal! - interact with many other medications, including SSRIs and meperidine (demerol)

Question 269

What is the tx goal for afib? What meds are used?

Answer 269

- want to keep ventricular rate below 100 bpm - can use either Bbs or CCBs * **usually require anticoagulation with warfarin too!

Question 270

ABCD acronym for skin lesions?

Answer 270

- A = asymmetry is more likely malignant - B = borders - ragged or blurred are more likely malignant - C = color - nonuniform color is more likely malignant - D = diameter - > 6cm is more likely malignant - E = elevation - raised surface is more likely malignant

Question 271

Operative vaginal deliveries: when can the be performed? How?

Answer 271

- only when the cervix is completely dilated, membranes are ruptured, the presenting part is the vertex of the scalp, and there is no disproportion btwn the size of the fetal head and the maternal pelvis - can be done with either forceps or vacuum assistance

Question 272

What type of oral contraceptive should be used in a breast-feeding woman?

Answer 272

-progestin only "minipill" --> a combined hormonal contraceptive can interfere with milk supply

Question 273

What are the features of benign PVCs and who are they commonly seen in?

Answer 273

- occur at rest and disappear with exercise | - commonly seen in athletes

Question 274

3 causes of atypical pneumonia?

Answer 274

1. Mycoplasma pneumoniae 2. Chlamydia pneumonia 3. Legionella pneumophillia

Question 275

Bipolar: dx

Answer 275

- manic episodes that last longer than 1 week that come on abruptly, not continuous - single episode of mania is sufficient for the dx of bipolar disorder

Question 276

Otitis media: ssx!

Answer 276

1. Red TM | 2. Decreased membrane mobility or fluid behind the TM --> necessary for dx!

Question 277

Dx of obstructive sleep apnea

Answer 277

- AHI or RDI > or = to 15 per hour (at least 15 obstructive events per hour), with or without sx - severe: > 30 per hr - moderate: 15-30 per hr - mild: 5-15 per hr

Question 278

Bipolar: tx

Answer 278

- mood stabilizers: 1. Valproate 2. Carbamazepine 3. Lithium * *use of antidepressants can precipitate acute manic behaviors

Question 279

How can digoxin be used with arrythmias?

Answer 279

-can slow down rapid ventricular rhythms that occur with a fib and flutter

Question 280

What do you do for contractions that are inadequate in frequency or power? What negative effect can it cause?

Answer 280

- can be augmented with an oxytocic agent - IV oxytocin is the drug of choice - can cause uterine hyperstimulation = 6 or more contractions in a 10-min period that cause abnormalities in the fetal heart rate --> reduce or take off the oxytocin, reposition the patient, and give oxygen via face mask!

Question 281

Failure rate of sterilization (male & female)

Answer 281

- <1 % | - sterilization should be considered irreversible!

Question 282

Most common causes of otitis external (3)?

Answer 282

1. Staphylococci 2. Streptococci 3. Pseudo = swimmers ear

Question 283

What are 3 most common cause of fetal tachy?

Answer 283

1. Maternal fever --> most common! 2. Medications 3. Fetal arrhythmias

Question 284

What is the Barlow test?

Answer 284

- with the child's hip and knee flexed at 90*, hold the knee and attempt to displace the thigh posteriorly - assesses for congenital hip deformities

Question 285

Most common cause of acute bronchitis? Tx?

Answer 285

- viral --> so antibiotics are not helpful | - bronchodilator tx (ex albuterol) & antitussive agents

Question 286

What is Naegele's rule for determining the delivery date?

Answer 286

-take the first day of the last menstrual period, subtract 3 months, add 7 days

Question 287

2 most common bacteria that cause acute bacterial sinusitis in adults?

Answer 287

1. S. pneumoniae | 2. H. Influenzae

Question 288

Trichomoniasis: 3 things that can predispose to infection?

Answer 288

1. Multiple sexual partners 2. Pregnancy 3. Menopause

Question 289

Trichomonas vaginitis: definition

Answer 289

- infection of the vagina caused by the protozoa trichomonas vaginalis - usually associated with a frothy green discharge and intense inflammatory response

Question 290

Contraindications for IUDs (6)?

Answer 290

1. Current or recent endometritis 2. PID 3. STD 4. Pregnancy 5. Anatomically distorted uterine cavity 6. Suspected or known HIV * *also, not ideal for multiple partners

Question 291

Brugada syndrome: how does it present on EKG? What can it cause?

Answer 291

- can present as ST-segment elevation in leads v1-v3 | - can cause dangerous arrhythmias that can cause death

Question 292

What is a common leg fracture seen in toddlers?

Answer 292

- spiral fractures of tibia --> from twisting on a planted foot - spiral fractures of other long bones (ex. Femur or humerus) are suspicious for child abuse

Question 293

Bacterial vaginosis: tx?

Answer 293

- oral and topical vaginal preparations of metronidazole or clindamycin - dont need to tx partner

Question 294

First stage of labor

Answer 294

- from onset of labor until the cervix is completely dilated - can be divided into: 1. Latent phase 2. Active phase

Question 295

What pregnancy category are nicotine patches?

Answer 295

-C

Question 296

Which 3 toxic compounds increase a pts risk for developing skin cancer?

Answer 296

1. Creosote 2. Arsenic 3. Radium

Question 297

Candida vulvovaginitis: definition

Answer 297

- vaginal and/or vulvar infection caused by Candida species | - usually with discharge and inflammation

Question 298

What are common non-cardiac causes of palpitations (10)?

Answer 298

1. Anemia 2. Electrolyte disturbances 3. Hyperthyroidism 4. Hypothyroidism 5. Hypoglycemia 6. Hypovolemia 7. Fever 8. Pheo 9. Pulmonary dz 10. Vasovagal syncope

Question 299

Most common bacterial causes of community-aquired pneumonia (3)?

Answer 299

1. Strep pneumonia 2. H. Influenzae 3. Moraxella catarrhalis

Question 300

Advanced maternal age?

Answer 300

-pregnant women who will be 35+ at the estimated delivery date

Question 301

What is the most common cause for a false positive serum in triple or quad screening? When are these tests usually done?

Answer 301

- incorrect gestational age dating | - usually done at weeks 10-14 gestation

Question 302

"Maternity blues" or AKA "baby blues"

Answer 302

- occurs in 30-70% of deliveries - develops within the first week after delivery and usually resolves by the 10th postpartum day - ssx: tearfulness, sadness, emotional lability

Question 303

Alcohol abuse

Answer 303

- harmful use of alcohol which can be either physical or mental harm - abusers drink despite recurrent social, interpersonal, and legal problems as a result of alcohol use

Question 304

What is an antalgic gait?

Answer 304

- occurs when the "stance" (weight-bearing) phase is shortened because of pain during weight bearing - the "stance" phase usually occupies 60% of the gain, while the "swing" (non-weight bearing) phase lasts for the rest

Question 305

5 components to an office-based intervention abut alcohol use? How long does it have to be?

Answer 305

- 5-10 min is effective 1. Establish rapport 2. Ask permission to discuss alcohol use 3. Provide feedback 4. Assess readiness 5. Enhance motivation, negotiate, and advise

Question 306

When should folic acid be started for prenatal health? What is the recommended dose?

Answer 306

- should be taken starting at least 1 month prior to conception - low-risk women should be taking 400 micrograms daily - higher risk women (w/ DM or seizures) should take 1mg a day - highest risk women (w/ child w/ neural tube defect) should take 4 mg a day

Question 307

What should be kept in mind with a pt > 50 who presents with palpitations?

Answer 307

-consider coronary artery disease

Question 308

What age do kids start saying "mama" and "dada"?

Answer 308

- start btwn ages 6-9mnths nonspecifically | - becomes specific btwn ages 8-12 mnths

Question 309

Fetal presentation

Answer 309

-the part of the fetus that is either foremost in the birth canal or in the closest proximity to the birth canal

Question 310

When should group B strep testing be offered to pregnant women?

Answer 310

-35-37wks via vaginorectal culture

Question 311

Who are oral contraceptives contraindicated in?

Answer 311

-women > 35 yrs old that smoke cigarrettes

Question 312

What is the AUDIT-C for? What are the questions? What is a positive screen?

Answer 312

- screening for at-risk, hazardous, or harmful drinking - questions: points assigned for each answer (0-4) 1. How often do you have a drink containing alcohol? 2. How many drinks containing alcohol do you have on a typical day when you do drink? 3. How often do you have more than 6 drinks on one occasion? - score of 3+ is positive

Question 313

When can a booster car seat start being used?

Answer 313

- when the child is > 40 lbs | - need lap and shoulder seatbelt too

Question 314

What is the tx of choice for GAS pharyngitis?

Answer 314

- penicillin | - cephalosporin and macrolides for pts allergic to penicillin

Question 315

What are 3 types of decelerations?

Answer 315

1. Early 2. Late 3. Variable

Question 316

Anovulatory bleeding tx?

Answer 316

- combined estrogen and progestin oral contraceptives or progestin alone - if no response, hysterectomy or endometrial ablative procedures can be done

Question 317

Latent phase of labor

Answer 317

- part of the first stage of labor | - contractions become stronger, longer, and more coordinated

Question 318

Tx for painful diabetic neuropathy?

Answer 318

-gabapentin = anti-convulsant

Question 319

Antenatal testing

Answer 319

-procedure that attempts to identify whether the fetus is at risk for uteroplacental insufficiency and perinatal death

Question 320

When can IUDs be replaced postpartum?

Answer 320

- at 6 wk postpartum visit | - earlier placement is associated with increased rate of exoulsion

Question 321

What ear condition are diabetics at risk for? Tx?

Answer 321

- invasive otitis externa caused by pseudo | - tx = surgical debridement of necrotic tissue + 4-6 wks of IV antibiotics if cranial bones are involved

Question 322

What is the most common cancer over all?

Answer 322

-basal cell carcinoma

Question 323

Flu shots and pregnancy

Answer 323

- women in their 3rd trimester should be offered the flu shot - safe for any stage of pre, if not allergic

Question 324

What is considered "at-risk" drinking?

Answer 324

- men = > 14 drinks per week or more than 4 drinks per occasion - women = > 7 drinks per week or more than 3 drinks per occasion

Question 325

What dies hip pain usually present with?

Answer 325

-pain in the groin, thigh, or even the knee

Question 326

SSRIs: sfx?

Answer 326

- sexual dysfunction - weight gain - GI disturbance - fatigue - agitation

Question 327

Cervical cap: use? Failure rate?

Answer 327

- use: dome shaped rubber cap that fits over cervix, must be used with spermicide, & must be properly fitted - harder to insert than diaphragm, may be left in place for up to 48 hrs - failure: 18%

Question 328

When should OM be tx with antibiotics and which are the 1st choice?

Answer 328

- tx when the infection is prolonged, recurrent, or severe - amoxicillin is the first choice - trimethoprim-sulfamethoxazole or cephalosporins can be alternates

Question 329

Endometritis

Answer 329

- polymicrobial infection of the endometrium of the uterus, usually caused by ascending infection from the vagina - can occur postpartum

Question 330

What are 4 causes of fetal bradycardia?

Answer 330

1. Maternal hypothermia 2. Certain medications given to the mother 3. Congenital heart block 4. Can be a sign of significant fetal distress * *usually anything bad that can happen to a fetus will cause a DECREASE in the fetal heart rate

Question 331

What are the expected rates of dilation in a woman without an epidural for a nulliparous woman and a parous woman?

Answer 331

- nulliparous = 1.2 cm per hour | - parous = 1.5 cm per hour

Question 332

Shoulder dystocia

Answer 332

- when the anterior shoulder will not readily pass below the pubic symphysis - this is an OBSTETRICAL EMERGENCY, it needs to be reduced via: 1. Hyperflexion if the hips 2. Suprapubic pressure 3. Episiotomy 4. Rotation of the fetal body in the vaginal canal

Question 333

What are patients with anxiety at high risk for developing?

Answer 333

-comorbid depression

Question 334

Spermicides: use? Failure rates?

Answer 334

- use: should be inserted into vaginal within 1 hr of intercourse & should be repeated if intercourse is repeated - failure: 20-30% failure rates, but when used with condoms, failure rate decreases to that of OCPs

Question 335

What is the gold standard for CHF dx?

Answer 335

- echocardiogram - can identify regional or global wall motion abnormalities, cardiomyopathy, ventricular or septal hypertrophy, and cardiac ejection fraction, etc.

Question 336

What does the quad screen test for?

Answer 336

1. hCG 2. Unconjugated estriol 3. Alpha-fetoprotein 4. Inhibin-A

Question 337

Mitral valve prolapse murmur?

Answer 337

- mid systolic click + late systolic murmur | - most common valvular defect in the US

Question 338

Varicella and rubella vaccinations and pregnancy?

Answer 338

- not advised during pregnancy | - rubella should be given to the infant after delivery if mom was nonimmune

Question 339

Bulla

Answer 339

-blister greater than 0.5 cm in diameter

Question 340

What 5 things do combination oral contraceptives offer protection against?

Answer 340

1. Ovarian cancer 2. Endometrial cancer 3. Iron-deficiency anemia 4. PID 5. Fibrocystic breast disease

Question 341

What are 3 signs of more severe pneumonia?

Answer 341

1. Tachycardia 2. Hypotension 3. Altered mental status

Question 342

What blood test can help determine if CHF is the cause of acute dyspnea?

Answer 342

-elevated BNP (>500)

Question 343

What legs pains are suspicious for malignancy in kids?

Answer 343

-pain that wakens the child at night

Question 344

What is the tx of choice for aspirin-sensitive asthma?

Answer 344

- leukotriene receptor antagonists: 1. Montelukast = singulair 2. Zafirlukast = accolate

Question 345

Third stage of labor: what is it? How long does it last?

Answer 345

- begins after the delivery of the baby and ends with the delivery of the placenta and membranes - typically lasts less than 3@ min, if longer = prolonged

Question 346

Billing's method

Answer 346

-method of contraception in which a woman keeps track of the changes in her cervical mucus to know when ovulation occurs

Question 347

What is considered "binge drinking"?

Answer 347

- pattern of drinking that brings the BAC to 0.08% in the past month - usually 5 or > drinks for a male or 4 or > drink for a female in approximately 2 hrs

Question 348

3 most common causes of pharyngitis is teens and you adukts?

Answer 348

1. Mycoplasma pneumoniae 2. Chlamydia pneumoniae 3. Arcanobacterium haemolyticus

Question 349

What is the CO2 level usually during an asthmatic attack?

Answer 349

- usually CO2 is low because of an increased respiratory rate - normalization of CO2 during an attack can be a sign of sever exacerbation

Question 350

What screening should be done on a pt with a malignant skin cancer hx?

Answer 350

-annual derm evaluations

Question 351

How can an undiagnosed congenital dysplasia of the hip present?

Answer 351

-a painless limp that is present from the time that the child learns to walk

Question 352

SNRIs: MOA

Answer 352

- inhibit the re-uptake of both serotonergic and noradrenergic systems - act on serotonergic systems at low dose - act on noradrenergic at higher dose

Question 353

Dx of PCOS

Answer 353

- need to have 2 of: 1. Hyperandrogenism 2. Chronic anovulation 3. Polycystic ovaries on ultrasound

Question 354

Lentigo maligna: what is it? Who is it commonly found in and where?

Answer 354

- most often found in elderly - usually on chronic sun-damaged skin, such as face, ears, arms, and upper trunk - least common melanoma, but most common in Hawaii

Question 355

What is the minimum SPF of sunscreen that should be worn?

Answer 355

-15

Question 356

Sick sinus syndrome: what is it? What can it lead to? Ssx?

Answer 356

- dysfunction of SA node - can lead to: 1. Bradycardia --> ssx = fatigue and syncope 2. Tachycardia-bradycardia --> ssx = palpitations and angina pectoris, caused by the SVTs

Question 357

Transdermal contraceptive: name? Hormones? Use? Sfx?

Answer 357

- name = ortho evra - hormones = norelgestromin (active metabolite of norgestimate) & ethinyl estradiol - use = 3 wks of 1 patch per week, then 1 patch free week to allow for withdrawal bleeding - sfx & efficacy = similar to OCPs

Question 358

Why would you test a child for hyperlipidemia?

Answer 358

-if there is a family history of hyperlipidemia or premature coronary artery disease

Question 359

Bacterial vaginosis and pregnancy?

Answer 359

-tx of asymptomatic BV in a pregnant woman can help reduce incidence of preterm labor

Question 360

What is the tx for a septic joint?

Answer 360

1. Urgent surgical irrigation and debridement, and antibiotics

Question 361

Variable deceleration

Answer 361

- abrupt decrease in fetal heart rate, usually followed by an abrupt return to the baseline - occurs variably in its timing, relative to a contraction - most commonly due to umbilical cord compression during contraction

Question 362

Which blood tests should be done in the initial workup for CHF (5)?

Answer 362

1. CBC 2. Electrolytes 3. Renal function tests 4. Liver function tests 5. Cardiac enzymes

Question 363

What is the antibiotic used for GBS prophylaxis?

Answer 363

- penicillin | - alternatives = ampicillin, cephalothin, erythromyocin, clinda, and vanco

Question 364

Mucopurulent cervicitis: dx?

Answer 364

- gold standard = culture of the cervical discharge | - take cultures even if asymptomatic bc 50-70% can be asymptomatic!

Question 365

Tx for alcohol withdrawal?

Answer 365

-benzodiazepines or phenobarbital

Question 366

When can a child ride in the front seat of a car?

Answer 366

- 13 yrs or older!

Question 367

Amblyopia

Answer 367

- reduction or loss of visions in one eye from lack of use | - strabismus is the most common cause of amblyopia

Question 368

Long QT syndrome: genetics? Who is it more common in?

Answer 368

- autosomal dominant - mutations in multiple genes - more common in females

Question 369

Bacterial vaginosis: dx?

Answer 369

- based on 3 of these 4 critera: 1. Thin homogenous discharge 2. Vaginal pH more than 4.5 3. Positive KOH "whiff" test (fishy odor present after addition of KOH to a sample of the discharge) 4. Presence of clue cells in a wet mount prep

Question 370

Asherman syndrome: sx? Cause?

Answer 370

- reduced vol of menstrual bleeding w/ REGULAR ovulation or even no menstration, with normal hormonal fctn - scarring w/in uterus caused by trauma from uterine curettage - not as common

Question 371

Acute management of asthma?

Answer 371

1. Immediate tx w/ a SABA + Monitor vitals and PEF 2. If in 20 min there is incomplete response, give 3 more SABA tx in 1 hr 3. If there is poor response, add oral or IV corticosteroids 4. Consider inpatient management if their continues to be an inadequate or poor response

Question 372

Slipped capital femoral epiphysis: what is it? Causes? Dx?

Answer 372

- what: separation of the growth plate that connects the metaphysis (femoral head) to the diaphysis (shaft of femur) - causes: can be caused by trauma, but often not - dx: early xrays = widening of the epiphysis, later xrays = slippage of head in relation to the shaft

Question 373

How long should a baby stay in a rear-facing car seat?

Answer 373

-until they weight at least 20lbs and are at least 1 yr old

Question 374

Omalizumab: name? MOA? Use?

Answer 374

- Xolair - monoclonal antibody - use only in colobo w/ asthma specialist - use in highest risk pts 12 yrs or older as additive tx for pts with severe persistent asthma that is sensitive to inhaled allergens - given subcutaneously every 2-4 wks

Question 375

Side effects of short acting beta-agonists?

Answer 375

1. Tremor 2. Anxiety 3. Heart pounding 4. Tachycardia (but not HTN)

Question 376

What are 2 antitussives that can be used to tx the cough in acute bronchitis?

Answer 376

1. Dextromethrophan | 2. Codeine

Question 377

Bupropion: sfx

Answer 377

- risk of seizures, avoid in pts with seizure hx or in bulimics - has less sexual sx

Question 378

Findings most commonly seen with GAS infections?

Answer 378

1. Abrupt onset of sore throat and fever 2. Tonsillar and/or palatal petechiae 3. Tender cervical adenopathy 4. Absence of cough

Question 379

What pregnancy category are the nicotine inhalers, nasal spray, and gum?

Answer 379

-category D

Question 380

What are minor sfx of OCPs?

Answer 380

1. Nausea 2. Headaches 3. Breast swelling 4. Fluid retention 5. Weight gain 6. Irregular bleeding 7. Depression

Question 381

What is safer, tubal ligation or vasectomy?

Answer 381

- vasectomy! | - done only under local anesthetics too!

Question 382

How do you tx moderate to severe asthma with steroids?

Answer 382

- inhaled corticosteroids are insufficient bc of their delayed onset of action - instead use oral steroid tx: - -1-2mg/kg per day for 3-10 days in kids - -40-60 mg per day for 5-10 days in adults

Question 383

What can reduce the absorption of the nicotine in both the gum and inhalers?

Answer 383

- acidic beverages | - should be avoided for 15 min after use

Question 384

"Growing pains" dx?

Answer 384

- diagnosis of exclusion - pain only at night - pain is bilateral - not present during the day - no other pathology is found

Question 385

What should be considered when a pt presents with multiple unrelated physical symptoms?

Answer 385

-depression!

Question 386

Which 5 meds can cause prolonged QT?

Answer 386

1. Quinidine 2. Procainamide 3. Sotalol 4. Amioderone 5. TCAs

Question 387

Brugada syndrome: what is it? Who is it most common in?

Answer 387

- ion channel disorder | - most common in Asian males

Question 388

What can prolonged rupture of membranes in pregnancy cause?

Answer 388

-can predispose to infection, especially if left ruptured for over 24hrs

Question 389

What is the diuretic of choice in CHF and why?

Answer 389

- furosemide = lasix | - acts as both a diuretic and immediately vasodilates the bronchial vasculature

Question 390

Theophylline: MOA? Use?

Answer 390

- mild to moderate bronchodilator | - used as an alternative, adjunctive tx w/ ICS, used as an add on

Question 391

How long does acute bronchitis usually last? How long does the cough usually last?

Answer 391

- usually lasts 2 weeks | - cough can last for 2 mnths or more

Question 392

Menometrorrhagia

Answer 392

-heavy menstrual flow or prolonged duration of flow (>7 days) that occurs at IRREGULAR intervals

Question 393

What are 3 common findings of a slipped capital femoral epiphysis?

Answer 393

1. Overweight adolescent male 2. Pain with internal rotation 3. External rotation on passive flexion of the affected hip

Question 394

6 complications of untreated GAS infections? Which can occur regardless of the infection being treated?

Answer 394

1. Rheumatic fever 2. Glomerulonephritis --> can occur regardless of tx!! 3. Toxic shock syndrome 4. Peritonsillar abscess 5. Meningitis 6. Bacteremia

Question 395

Mallampti score: what is it? What is it used for?

Answer 395

- When the pt opens mouth and says "ahh": 1. Entire tonsil visible 2. Upper half of tonsil fossa visible 3. Soft palate and hard palate visible 4. Only hard palate visible - score of 3 or 4 is suggestive of obstructive sleep apnea

Question 396

What medications can be used to stop SVTs?

Answer 396

- IV adenosine can be used, if it works, then the rhythm was due to a reentrant SVT - if the adenosine doesnt work, then use either Bb or CCB & consult to cardio!

Question 397

How can a pt self treat SVTs?

Answer 397

1. Carotid sinus massage 2. Valsalva maneuver 3. Cold application to the face * *all trigger vagal nerve stimulation

Question 398

Most common causes of postpartum fever?

Answer 398

1. especially if associated with uterine tenderness and foul smelling lochia = sign of endometritis - seen in 10% of all c-sections 2. UTI 3. All other common causes of infection post surgery = atelectasis, wound infections, venous thromboembolic dz, etc.

Question 399

How long is the postpartum period?

Answer 399

-starts after the delivery of the placenta and lasts 6-12 wks

Question 400

What should be assessed in all pts complaining of depressive sx?

Answer 400

-substance abuse,esp of alcohol, cocaine, and methamphetamine

Question 401

What is the effect of an epidural on the times of labor?

Answer 401

-can prolong the times

Question 402

What are the CAGE questions?

Answer 402

1. Have you ever felt the need to Cut down on your drinking? 2. Have people Annoyed you about your drinking? 3. Have you ever felt bad or Guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? * *yes to two or more = positive screen

Question 403

Sponge: use? Failure rate? Sfx?

Answer 403

- donut shaped sponge that has spermicide on it and is inserted into vagina before intercourse - OTC, one time use only - failure: 18-28% - sfx: TSS (rare!!)

Question 404

What 3 test should be done in the initial work up of menstrual irregularities?

Answer 404

1. Pregnancy test 2. TSH 3. Prolactin levels

Question 405

TCAs: sfx?

Answer 405

1. Sedation 2. Dry mouth 3. Dry eyes 4. Urinary retention 5. Weight gain 6. Sexual disturbance * * fatal if overdose!!

Question 406

What is the first priority in CHF and how do you achieve that?

Answer 406

- optimize oxygen exchange 1. Administer o2 via nasal cannula 2. Dilate pulmonary vasculature 3. Decrease cardiac preload and afterload

Question 407

Postpartum psychosis

Answer 407

- rare - manic and frank delusional behaviors that present within a few days to a few weeks after delivery - tx: hospitalization & co management with a psychiatrist - high risk of suicide and infanticide without tx!

Question 408

What drugs can OCPs prolong the effects of?

Answer 408

1. Theophylline 2. Benzodiazepines 3. Caffeine

Question 409

Varenicline: sfx?

Answer 409

- associated w/ neuropsychic sx, ex. Changes in behavior, agitation, depression, and suicidal behaviors - use with caution in pts with hx of psych disorders - monitor pts closely

Question 410

When is a TDaP recommended?

Answer 410

-at ages 2, 4, 6, and 12-15 mnths, and at age 4-6yrs

Question 411

Pneumococcal vaccine recommendations?

Answer 411

1. All pts over 65 yrs and older 2. All adults with chronic cardiopulmonary diseases 3. All immunocompromised persons - revaccinate every 5 years in pts that have a decline in antibody titers

Question 412

Aspirates in septic joint v transient synovitis

Answer 412

- Septic joint = Purulent aspirate, with WBC count > 50,000 | - transient synnovitis = yellow/clear aspirate w/ WBC count < 10,000

Question 413

What is the most common cause of anemia in children? What helps reduce these incidences?

Answer 413

- iron deficiency | - iron containing formula and cereals have helped reduce these incidences

Question 414

Dysfunctional uterine bleeding (DUB)

Answer 414

- unpredictable bleeding - abnormality present in the hypothalamic-pituitary-ovarian axis - common shortly after menarche and before menopause, when it occurs other times can mean anovulation --> evaluate with prolactin and LH levels!

Question 415

When is bereavement considered major depression?

Answer 415

-when the sx last for more than 2 mnths and involve suicidal ideations, morbid preoccupations, or psychosis

Question 416

Which cardiac or structural problems can lead to palpitations (7)?

Answer 416

1. Cardiomyopathy 2. Atrial or ventricular septal defects 3. Congenital heart disease 4. Mitral valve prolapse 5. Pericarditis 6. Valvular heart dz 7. CHF

Question 417

What should be done on physical exam for a pt presenting with palpitations?

Answer 417

1. Vitals 2. Orthostatic bp if necessary 3. Thyroid exam (also look for resting tremor or brisk reflexes) 4. PMI 5. Rate/rhythm/murmurs

Question 418

Varencline: MOA

Answer 418

- nicotinic receptor partial agonist | - can reduce cravings for nicotine, reduce withdrawl sx, and block binding of some of the nicotine from cigarettes

Question 419

Nodular melanoma: characteristics?

Answer 419

- most aggressive melanoma | - usually invasive at time of diagnosis

Question 420

Female condom: use? Protection against STDs? Failure rate?

Answer 420

- use: one ring inserted into vagina, the other remains outside - STDs: may offer some protection, but male condoms must be used for highly effective protection - failure rate: 21-26%

Question 421

Pelvic inflammatory disease: what is it?

Answer 421

- inflammation of the upper genital tract - includes pelvic peritonitis, endometritis, salpingitis, and tuboovarian abscess caused by infection with gonorrhea, chlamydia, or vaginal and bowel flora

Question 422

Apnea

Answer 422

-in adults = breathing pauses that last at least 10 sec and are accompanied by 90% or more drop in airflow

Question 423

Uterine atony: tx?

Answer 423

- first give IV oxytocin and do a bimanual uterine massage - if those fail, give methylergonovine IM (dont give to pt w/ HTN) - if that fails, give prostaglandin F2a (dont give to pts with asthma)

Question 424

Menorrhagia

Answer 424

-excessive menstrual flow, or prolonged duration of flow (>7 days) that occurs at REGULAR intervals

Question 425

What are the3 major long-acting agents that can be used to tx asthma?

Answer 425

1. Inhaled corticosteroids = ICS 2. Leukotriene receptor antagonists = LRA 3. Long-acting beta2-agonists

Question 426

How does basal cell carcinoma present? Prognosis? Tx?

Answer 426

- pearly papules with central ulceration or multiple telangiectasias - present with growing lesions that sometimes bleed or itch - rarely metastasize, but grow large and can be locally destructive - tx = excision

Question 427

When is an ultrasound indicated in pregnancy?

Answer 427

- not mandatory in routine, low-risk prenatal care - indicated for evaluation of: 1. uncertain gestational age 2. Size/date discrepancies 3. Vaginal bleeding 4. Multiple gestations 5. Other high-risk situations

Question 428

What should infants less than 1yr old be fed?

Answer 428

- breast-fed or given an iron-containing formula | - cereals and other baby foods can be introduced btwn ages 4-6mnths

Question 429

Exercise-induced asthma

Answer 429

-10% lowering of FEV1 when challenged with exercising

Question 430

What are 2 major contraindications to giving a vaccine?

Answer 430

1. Anaphylactic rxn to a specific vaccine in the past, or a component of the vaccine 2. Current severe illness

Question 431

PID: dx?

Answer 431

-lower abdominal tenderness with both adenexal and cervical motion tenderness without another explanation = enough to dx PID

Question 432

Which percentage of fetuses with down syndrome are born to women under age 35?

Answer 432

-75%!!

Question 433

Delerium tremens sx?

Answer 433

1. Hallucinations 2. Agitation 3. Tremor 4. Sleeplessness 5. Sympathetic hyperactivity * *can result in fatal arrhythmias or infections!

Question 434

Bupropion: contraindications?

Answer 434

- pts with eating disorder = electrolyte imbalances can lead to seizures bc seizure threshold is decreased - pts on MAOis w/in last 2 wks - pts w/seizure dissorders

Question 435

What are two tests for strasbismus? What should be done when strabismus is detected?

Answer 435

1. Asymmetric light reflexes off corneas 2. Cover-uncover test = have child focus on an object with both eyes, cover one of their eyes, if the uncovered eye deviates to focus on the object, then strabismus is suggested * *ot should be referred to a pediatric ophthalmologist as soon as strabismus is detected!

Question 436

Bacterial vaginosis: STD?

Answer 436

- NOT an STD, but associated with having multiple sex partners - overgrowth of anaerobic bacteria and G vaginalis

Question 437

How do you use bupropion?

Answer 437

- start 1-2 weeks before quit date - start at 150 mg a day for 3 days, then increase to 150mg twice a day - usually used for 7-12 weeks, but it can be used for up to 6 mnths - can be used alone or with nicotine replacements

Question 438

Typical use effectiveness (w/comtraceptives)

Answer 438

-overall efficacy in actual use, when forgetfulness and improper use occur

Question 439

What test is recommended once a dx of MVP is made?

Answer 439

-echo to look for complications, such as: mitral regurg or LVH

Question 440

Cromolyn sodium: MOA? Use? Sfx?

Answer 440

- stabilizes the mast cells and interferes with chloride channel fctn - can be used for tx of mild persistent asthma - have few side effects, but must be used multiple times per day

Question 441

Two types of IUDs available? MOA? How long do they last for? Failure rates?

Answer 441

1. ParaGard - MOA: copper - lasts: 10 yrs - failure: 4-5% 2. Mirena - MOA: progestin - lasts: 5 yrs - failure: < 1%

Question 442

What does squamous cell carcinoma look like? Prognosis? Tx?

Answer 442

- irregularly shaped plaques or nodules with raised borders. Can be scaly, ulcerated, and can bleed easily - higher rate of mets than basal cell - tx = complete excision

Question 443

What are the 4 most common reasons for cesarean deliveries?

Answer 443

1. Prior cesarean 2. Breech presentation 3. Arrest of labor or descent 4. Fetal distress that needs immediate delivery

Question 444

Hypopnea

Answer 444

- 50% reduction in airflow that lasts at least 10 sec with a 3% drop in oxygen sat - or a 30% reduction in airflow lasting at least 10 sec with a 4% drop in oxygen sat

Question 445

Otitis externa s/sx?

Answer 445

- pain can be severe - itching - inflamed, swollen, external ear canal - often see exudates and discharge

Question 446

At what age can a modified snellen chart be used to test a child's vision?

Answer 446

-age 3

Question 447

What should be done with an evolving lesion or one that has ABCDE features?

Answer 447

- should be excised completely with a 2mm to 3mm margin around the lesion - shave biopsies can be done for raised lesions - punch biopsies for flat lesions - if lesion is too large to excise, do a bx through the most suspicious looking section

Question 448

What are pts with long QT syndrome at risk for?

Answer 448

1. Ventricular arrhythmias | 2. Sudden cardiac death

Question 449

Risk factors for Hospital-acquired pneumonia (4)?

Answer 449

1. Intibation 2. NG tube 3. Preexisting lung disease 4. Multisystem failure

Question 450

What is the target for HDL?

Answer 450

-60 or greater

Question 451

Sulfonylureas: sfx

Answer 451

1. Weight gain | 2. Hypoglycemia

Question 452

Partner notification for STDs: Mandatory? How reported?

Answer 452

- yes, it is mandatory - either the patient notifies the partner, or if they refuse to the department of health will notify the partner - health care provider has legal and ethical obligation to inform the partners that they are at risk

Question 453

Pramlinitide: sfx

Answer 453

1. Hypoglycemia | 2. Nausea & diarrhea

Question 454

How is HTN and the risk CV disease related?

Answer 454

-risk of CV dz doubles with each increase in bp of 20/10 mmHg above 115/75 mmHg

Question 455

DPP-4 inhibitor: sfx?

Answer 455

1. upper respiratory syndromes | 2. severe hypersensitivity (ex. Anaphylaxis)

Question 456

LDL goal for pts with very high risk of CHD? AKA "therapeutic option"

Answer 456

-70 mg/dL or less

Question 457

Reccomendations for measuring lipid levels?

Answer 457

- every 5 years in all adults over the age of 20 | - can be fasting or nonfasting

Question 458

LDL goal for pt with zero to one risk factor?

Answer 458

- 160 mg/dL or less

Question 459

Effects of statins?

Answer 459

- vv LDL ** - ^^ HDL - vv TGs

Question 460

Lachman test: describe? what structure does it test? what injury does it identify?

Answer 460

- with pt knee in 20* flexion, pull forward on the upper tibia while stabilizing the upper leg - tests: ACL - positive: excessive translation with no solid endpoint = ACL tear

Question 461

What is a normal GFR for a woman?

Answer 461

-btwn 100 and 120

Question 462

What blood tests should be drawn on any obese pt?

Answer 462

1. Fasting glucose - to look for DM and impaired glucose tolerance 2. Fasting lipids - to look for metabolic syndrome and to determine CV dz risks 3. TSH - screen for hypoTH 4. Liver enzymes - look for fatty liver dz

Question 463

Ottawa knee Rules:

Answer 463

- knee x-rays should be performed when any of these are present: 1. age 55+ 2. isolated patella tenderness 3. tenderness of head of the fibula 4. inability to flex the knee to 90* 5. inability to bear weight for four steps immediately and in the exam room (regardless of limping)

Question 464

What is the most common cause of low back pain? What is the possible physiology?

Answer 464

- lumbar strain is the most common - probably caused by an incomplete tear in the annulus fibrosus that leaks fluids that cause local inflammation and irritation

Question 465

Ottawa Ankle Rules

Answer 465

- have very high sensitivity for ruling out significant malleolar and midfoot fractures - X-rays of the ankle should be performed if: 1. bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus 2. patient unable to bear weight immediately or when examined - foot X-rays should be performed if: 1. bony tenderness over the medial midfoot, base of 5th metatarsal (lateral midfoot) 2. pt is unable to bear weight

Question 466

What is cardiogenic nausea and vomiting associated with?

Answer 466

-larger MI

Question 467

What 7 tests should be done in a pt with diagnosed with HTN?

Answer 467

1. Blood glucose 2. Serum potassium 3. Creatinine 4. Ca levels 5. Hematocrit 6. Urinalysis - to look for proteinuria or cells 7. EKG

Question 468

Bile acid sequestrants: sfx?

Answer 468

1. GI distress, constipation | 2. Decreased absorption of other meds

Question 469

What 3 common types of drugs can cause dyslipidemia?

Answer 469

1. Progestins 2. Anabolic steroids 3. Corticosteroids

Question 470

Alpha-glucosidase inihibitors: sfx

Answer 470

- GI side effects, including gas and bloating | - contraindicated in ketoacidosis and in hepatic disorders

Question 471

What 4 drugs can be used to suppress tics in tourettes?

Answer 471

1. Haloperidol 2. Pimozide 3. Trifluoperazine 4. Fluphenazine

Question 472

Alpha-glucosidase inhibitors: MOA

Answer 472

- delay carbohydrate absorption via inhibiting alpha glucosidase - decreases postprandial hyperglycemia - can be beneficial to pts with erratic eating habits bc hypoglycemia will not occur if meals are skipped

Question 473

Cholesterol absorption blockers: name

Answer 473

-ex. Ezetimibe

Question 474

Nicotinic acids: contraindications?

Answer 474

1. Absolute: chronic liver dz & severe gout | 2. Relative: DM, hyperuricemia, & peptic ulcer dz

Question 475

Inversion stress test: describe? what structure does it test? what injury does it identify?

Answer 475

- invert pts ankle with one hand while stabilizing the lower leg with the other hand - tests: calcaneofibular ligament - positive: excessive mvmnt or palpable "chunk" or talus on tibia = ligament tear

Question 476

Where are thiazolidinediones metabolized?

Answer 476

- in the liver! | * *so they can be used in pts with renal dz!

Question 477

What is the maximum target bp for diabetics?

Answer 477

-130/80

Question 478

When should imaging be done for a herniated disc? Which is best?

Answer 478

-an MRI should be done AFTER 4 weeks

Question 479

What is the gold standard for an obesity tx plan?

Answer 479

- combination of: 1. Dietary restrictions 2. Increased physical activity 3. Behavioral therapy

Question 480

What are the 4 tx of acute mechanical back pain?

Answer 480

1. NSAIDS 2. Muscle relaxants 3. Heat 4. Early mobility --> NO more than 2 days of bed rest!

Question 481

What is the most common cause of ankle sprains? What is more common, medial or lateral sprains? Why?

Answer 481

- inversion of an ankle that is plantar flexed | - lateral is more common than medial, because the lateral ligaments are relatively weaker

Question 482

Which pts are potential candidates for bariatric surgery?

Answer 482

-pts with BMI > than 40, or greater than 35 with comorbid conditions

Question 483

What EKG changes can be seen with an MI and what labs are also seen?

Answer 483

- EKG: also see ST-segment elevation or depression &/or T-wave inversion * *NOT all MIs will have EKG changes!! - labs: elevated CK-MB &/or elevated troponin levels

Question 484

Cauda equina syndrome sx (4)

Answer 484

1. Increasing neurological deficits and leg weakness 2. Bowel and urinary incontinence 3. Sensory loss in a saddle distribution 4. Bilateral sciatica

Question 485

Fibric acids: contraindications?

Answer 485

1. Severe renal dz | 2. Severe hepatic dz

Question 486

What is preHTN?

Answer 486

-bp btwn 120-139 systolic and 80-89 diastolic

Question 487

What does unequal carotid pulses or upper extremity pulses indicate?

Answer 487

- aortic dissection | * *but most patients with dissection will not have uneven pulses!

Question 488

Cholesterol absorption blocker: effects?

Answer 488

- vv LDL ** - ^^ HDL - vv TG

Question 489

Drop-arm rotator cuff test: describe? what injury does it identify?

Answer 489

- pt is unable to lower his arm slowly from raised position | - positive = large rotator cuff tear

Question 490

Drop-arm rotator cuff test: describe? what injury does it identify?

Answer 490

- pt is unable to lower his arm slowly from raised position | - positive = large rotator cuff tear

Question 491

Further testing to be done with initial workup of hyperlipidemia? (4)

Answer 491

1. Blood glucose 2. Creatinine 3. Liver function tests 4. TSH

Question 492

Varus stress test: describe? what structure does it test? what injury does it identify?

Answer 492

- with the pts leg in full extension and at 30* flexion, add lateral-directed force on the knee and medial-directed force on the ankle - tests: lateral collateral ligament - positive: excessive translation = tear

Question 493

What EKG changes make the dx of an MI most difficult?

Answer 493

-Left bundle branch block

Question 494

Initial tx of spinal stenosis?

Answer 494

1. NSAIDS 2. Physical therapy 3. Epidural corticosteroids

Question 495

Anterior drawer ankle test: describe? what structure does it test? what injury does it identify?

Answer 495

- pull forward on the pt's heel while stabilizing the lower leg with the other hand - tests: anterior talofibular ligament - positive = ATFL tear

Question 496

What BMI is considered underweight? Normal? Overweight? Obese? Extremely obese?

Answer 496

- underweight: < 18.5 - normal: 18.5-24.9 - overweight: 25.0-29.9 - obese: I-30-34.9 II-35-39.9 - extreme obesity III: > 40

Question 497

What kind of anemia can be seen with kidney disease and why?

Answer 497

- normocytic anemia | - decreased epo from the kidneys

Question 498

Why are ACEi given after an MI?

Answer 498

- reduce short-term mortality when started w/in 24 hrs of acute MI - prevent left ventricle remodeling and recurrent ischemic events

Question 499

Best tx for sprained ankle?

Answer 499

"PRICE" - Protection - Rest = to promote healing, but early rehab is necessary - Ice = minimizes swelling - Compression = reduces swelling - Elevation = reduces swelling - plus NSAID or acetaminophen as needed for the pain

Question 500

Sulfonylureas: MOA

Answer 500

-act as insulin secretagogues, stimulate beta cells to secrete insulin

Question 501

Cholesterol absorptiom blocker: sfx?

Answer 501

1. Abdominal pain | 2. Diarrhea

Question 502

What are the exercise recommendations for weight loss?

Answer 502

-at least 30 min a day of moderate to vigorous physical activity for 5 days a week

Question 503

What does the straight-leg-raise test for? What else can be used?

Answer 503

- sciatica | - contralateral leg raise test can also be used

Question 504

How many elevated bps to diagnose HTN?

Answer 504

-two properly taken bps at 2 different visits

Question 505

Bile acid sequestrants: contraindications?

Answer 505

-dybetalipoproteinemia = TG > 400

Question 506

Lift off test: describe? what structure does it test? what injury does it identify?

Answer 506

- pt places dorsum of hand on lumbar back and attempts to lift hand off back - tests: subscapularis - positive = rotator cuff injury or tear

Question 507

Thiazolidinediones: MOA

Answer 507

1. Improve insulin sensitivity in muscle and in adipose tissue 2. Decrease hepatic gluconeogenesis and increase peripheral glucose utilization Also: 3. Decrease TGs 4. Increase HDL

Question 508

Outflow murmur that increases in intensity when lying down?

Answer 508

-functional outflow murmur that can be common in athletes

Question 509

What does metformin do?

Answer 509

1. Acts on liver to decrease glucose output during gluconeogenesis 2. Also improves insulin sensitivity in the liver and muscle In addition: 3. Reduces insulin levels 4. Potential for weight loss 5. Decrease in TGs 6. Decrease in LDL ** doesnt cause hypoglycemia!!

Question 510

What can be used to tx levadopa-related motor complications in parkinsons?

Answer 510

- dopamine agonists: 1. Catechol O-methyltransferase inhibitors 2. MAOis

Question 511

What are common psych probs seen with parkinsons?

Answer 511

1. Depression 2. Dementia 3. Psychosis

Question 512

Why can pts with kidney disease have vomitting?

Answer 512

- due to the build up of urea and other toxins | - persistent vomiting = need tx!

Question 513

What to do if you suspect the pt has limited ROM bc of pain?

Answer 513

-inject lidocaine into the joint to numb it then repeat the exam

Question 514

Which 4 strains does the HPV vaccine work against?

Answer 514

- 6 & 11 = genital warts | - 16 & 18 = cervical dysplasia and cancer

Question 515

What should all sexually active adolescents be screened for?

Answer 515

- chlamydia and gonorrhea via cervical sampling in females and a leukocyte esterase test in males - all should also be offered HIV testing

Question 516

Tx for volume overload associated with chronic renal failure?

Answer 516

1. Sodium restriction | 2. Loop diuretics

Question 517

12 Red Flag sx of low back pain?

Answer 517

1. Unrelenting night pain 2. Unrelenting pain at rest 3. Neuromotor deficit 4. Fever 5. Loss of bowel or bladder control 6. Suspicion of ankylosing spondylitis 7. Trauma 8. History or suspicion of cancer 9. Osteoporosis 10. Chronic corticosteroid use 11. Immunosuppression 12. Drug or alcohol abuse

Question 518

What is the most common cause of persistently stiff, painful, or unstable joints following sprains?

Answer 518

-inadequate rehab

Question 519

What changes seen in EKG indicate angina?

Answer 519

- ST elevation or depression | - T-wave inversion

Question 520

What are 4 sx of pulmonary edema?

Answer 520

1. Shortness of breath 2. Lower-extremity edema 3. JVD 4. Abnormal lung sounds (ex. Rales)

Question 521

Cholesterol absorption blockers: contraindictaions?

Answer 521

1. Hepatic insufficiency | 2. Active liver dz

Question 522

What cardiac problem can hypoMg cause?

Answer 522

-torsades de pointe ventricular tachy

Question 523

What are the 2 most common cause of chest pain in the outpatient setting?

Answer 523

1. musculoskeletal causes | 2. GI cause

Question 524

What are patients with Chronic kidney disease most likely to die of?

Answer 524

-more likely to die of CV dz before they develop ESRD and need dialysis

Question 525

What is the target HbA1C for diabetics usually?

Answer 525

-6.5% or less

Question 526

Sprain

Answer 526

-stretching or tearing injury of a ligament

Question 527

Stage 1 HTN bp?

Answer 527

- systolic 140-159 | - diastolic 90-99

Question 528

What is the target for total cholesterol?

Answer 528

-less than 200

Question 529

What are the 9 risk factors for CAD?

Answer 529

1. DM 2. Dyslipidemia 3. Age 4. HTN 5. Smoking 6. Family hx of early CAD 7. Male gender or postmenopause women 8. LVH 9. Homocystinemia

Question 530

What are the 3 ankle sprain grades? What are their associated sx?

Answer 530

1. grade 1 - stretching of ATFL = pain and swelling, but NO mechanical instability and little to NO functional loss, can bear weight with mild pain 2. grade 2 - partial tear of ATFL = more severe pain, swelling, and BRUISING + mild-moderate joint instability + loss of range of motion 3. grade 3 - complete tear of ATFL and CFL with partial tear of PTFL = significant joint instability, LOSS of function + INABILITY to bear weight

Question 531

Empty can test: desribe? what structure does it test? what injury does it identify?

Answer 531

- arm abducted, elbow extended, thumb pointing down, pt elevates arm against resistance - tests: supraspinatus - positive = rotator cuff injury or tear

Question 532

LDL goal for pt with CHD or CHD equivalent?

Answer 532

-100 mg/dL or less

Question 533

Stage 2 HTN bp?

Answer 533

- systolic: > 160 | - diastolic: > 100

Question 534

What is metabolic syndrome?

Answer 534

- insulin resistance - characterized by: 1. Abdominal obesity = waist circumference > 102 cm in men and > than 88 cm in women 2. Dyslipidemia = TG > 150 mg/dL & HDL < 40 in men and < 50 in women 3. Elevated bp = > 130/85 4. Impaired fasting glucose = > 110 mg/dL

Question 535

Nicotinic acids: effects

Answer 535

- vv LDL - ^^ HDL - vv TG **

Question 536

Nicotinic acids: sfx?

Answer 536

1. Flushing 2. Hyperglycemia 3. Hyperuricemia 4. Upper GI distress 5. Hepatotox

Question 537

What makes sciatica worse?

Answer 537

- valsalva - sneezing - coughing

Question 538

What can happen to the bp if the cuff is too small?

Answer 538

-falsely elevated

Question 539

Varus stress test: describe? what structure does it test? what injury does it identify?

Answer 539

- with the pts leg in full extension and at 30* flexion, add lateral-directed force on the knee and medial-directed force on the ankle - tests: lateral collateral ligament - positive: excessive translation = tear

Question 540

External shoulder rotation test: describe? what structure does it test? what injury does it identify?

Answer 540

- elbows at sides and flexed at 90*, pt externally rotates against resistance - tests: infraspinatus Teres minor - positive = rotator cuff injury or tear

Question 541

Empty can test: describe? what structure does it test? what injury does it identify?

Answer 541

- arm abducted, elbow extended, thumb pointing down, pt elevates arm against resistance - tests: supraspinatus - positive = rotator cuff injury or tear

Question 542

What 2 drugs are indicated for long term tx of obesity?

Answer 542

1. Orlisat | 2. Sibutramine

Question 543

What typically happens to murmurs with the valsalva maneuver?

Answer 543

- most decrease in intensity | - murmurs from hypertrophic cardiomyopathy will INCREASE with the valsalva though!

Question 544

What is the conservation tx for sciatica?

Answer 544

1. NSAIDS 2. Short-course steroids 3. Avoidance of sitting

Question 545

Pramlitide: MOA

Answer 545

- amylinomimetic agent that is similar in action to human amylin - inhibits inappropriately high glucagon secretion during hyperglycemia (ex. After meals) - works in both type 1&2 DM - does not impair physiologic response to hypoglycemia

Question 546

Chest pain with angina v. MI?

Answer 546

- chest pain with angina usually resolves in less than 5 min with rest - chest pain with an MI should be suspected when the pain lasts longer than 20-30 min

Question 547

Ottawa Ankle Rules

Answer 547

- have very high sensitivity for ruling out significant malleolar and midfoot fractures - apply to adults who have normal mental status, dont have any other painful injuries, and are seen w/in 10 dyas of their injury - X-rays of the ankle should be performed if: 1. bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus 2. patient unable to bear weight immediately or when examined - foot X-rays should be performed if: 1. bony tenderness over the medial midfoot, base of 5th metatarsal (lateral midfoot) 2. pt is unable to bear weight

Question 548

What are the 5 factors used to determine the LDL goal?

Answer 548

1. Cigarette smoking 2. HTN 3. Low HDL --> high HDL = negative risk factor (so subtract 1 from total risk factors) 4. Age (45+ for men and 55+ for females) 5. Family Hx of premature CHD (male < 55 or female < 65)

Question 549

Systolic murmur that decreases in intensity when the pt is lying down?

Answer 549

- hypertrophic cardiomyopathy | - lying down increases ventricular filling = decreases obstruction

Question 550

What are the 3 most common causes of chronic kidney disease?

Answer 550

1. Diabetes 2. HTN 3. Glomerulonephritis

Question 551

Which 5 groups of pts should get a hep A vaccine?

Answer 551

1. Live in areas with high infection rates 2. Travel to high-risk areas 3. Have chronic liver dz 4. Use IV drugs 5. Men who have sex with men

Question 552

What is the first-line primary tx for HTN?

Answer 552

-thiazide diuretics

Question 553

What does it mean when small kidneys are seen on imaging?

Answer 553

- reflects irreversible disease | - they should rarely be biopsied bc the results will not alter the tx

Question 554

What is the target bp for HTN in average pts? In diabetics and pts with kidney dz?

Answer 554

- 140/90 in "normal pts" | - 130/80 in diabetics and pts with kidney dz

Question 555

What do Q waves mean?

Answer 555

- can indicate cardiac pathology, but usually mean there is an old infarct - when Q waves are present the benefits of thrombolytic tx is uncertain

Question 556

What are the alcohol reccomendations for a pt with HTN?

Answer 556

-no more than 2 a day for men and no more than 1 a day for females

Question 557

What are the 4 ways to assess a patient's volume status?

Answer 557

1. Skin turgor 2. Mucous membranes 3. Specific gravity of urine 4. Orthostatic bp

Question 558

Best tx for sprained ankle?

Answer 558

"PRICE" - Protection - Rest - Ice - Compression - Elevation - plus NSAID or acetaminophen as needed for the pain

Question 559

What are the 6 risk factors for gestational diabetes?

Answer 559

1. > 25 yrs old 2. High-incidence race = native american, african american, hispanic, south or east asian, or pacific islander 3. BMI > 25 or more 4. History of glucose intolerance 5. Previous history of gestational diabetes 6. History of DM in a first degree family member

Question 560

Nicotinic acids: name

Answer 560

-ex. Niacin

Question 561

LDL goal for pt with 2+ risk factors?

Answer 561

-130 mg/dL or less

Question 562

What 3 medications can be used to tx an essential tremor?

Answer 562

1. Propanol 2. Primidone 3. Gabapentin

Question 563

Spinal stenosis: ssx?

Answer 563

1. lower back pain 2. Leg pain 3. Leg weakness 4. Pseudoclaudication = occurs after walking various distances while the vascularity in the legs remain intact. * * Pain is relieved by bending over or sitting.

Question 564

Disadvantages of thiazolidinediones?

Answer 564

1. Slight increase in LDL 2. Weight gain 3. Slow onset of action 4. Can cause water retention

Question 565

Strain

Answer 565

-stretching or tearing injury of a muscle or tendon

Question 566

In which 4 groups of patients is a BMI not an accurate assessment of lean body mass to body fat ratio?

Answer 566

1. Highly muscled people (ex. Body builders, weight lifters, athletes) 2. Pregnant women 3. Patients with symptomatic congestive heart failure

Question 567

Common side effects of metformin? How can they be reduced?

Answer 567

- nausea and diarrhea and other GI sfx are common | - can be decreased by giving smaller doses and taking meds with meals

Question 568

Metlitinides: MOA

Answer 568

- short acting secretagogues, increase insulin secretion from the pancreas - taken no more than 1 hr before meals - have rapid onset and short duration of action - useful in pts that have have blood sugars that vary with meal time but have constant sugars throughout the day

Question 569

Definition of End Stage Renal Disease

Answer 569

- irreversible loss of kidney function - the patient is permanently dependent on renal replacement therapy (either dialysis or transplant) - GFR < 15

Question 570

When are complete physical examinations in adolescents reccommended?

Answer 570

-once during early adolescence, once in mid adolescence, and once in late adolescence

Question 571

Disadvantages of meglitinides?

Answer 571

1. Risk of hypoglycemia 2. Expensive 3. Should not be used in pts with hepatic dysfunction

Question 572

What is the imaging study of choice for musculoskeletal injuries?

Answer 572

- plain x-rays --> must do at least 2 views that are at 90* to each other - if normal and sx continue, then do an MRI

Question 573

What is the minimal decrease in BMI that can provide benefit to the patient?

Answer 573

-5% decrease

Question 574

Statins: sfx

Answer 574

- myopathy & myalgia | - increased liver enzymes

Question 575

What is used to monitor ots at risk for kidney disease?

Answer 575

1. Serum creatinine to estimate GFR | 2. Random urinalysis for albuminuria

Question 576

Bile acid sequestrants: names

Answer 576

1. Cholestyramine 2. Colestipol 3. Colesevelam

Question 577

Squeeze test: describe? what structure does it test? what injury does it identify?

Answer 577

- compresses tibia and fibula at midcalf - tests: syndesmosis - positive: pain at anterior ankle joint (below where squeezing) = syndesmotic injury

Question 578

What 3 medications are known to cause or enhance a physiologic tremor?

Answer 578

1. Inhaled Beta-agonist (ex. albuterol) 2. Levothyroxine 3. Lithium

Question 579

What can be a cause of tremor in a pt younger than 40?

Answer 579

-wilson's dz

Question 580

Athletes with which 4 types of murmurs should be held from participation?

Answer 580

1. Systolic murmur with an intensity greater than 3/6 2. Diastolic murmur 3. Holosystolic murmur 4. Continuous murmur * * or any other suspicious murmur!

Question 581

What is sciatica a classic sign of?

Answer 581

-a herniated disc

Question 582

Diagnostic criteria for DM?

Answer 582

1. Random glucose of 200 mg/dL or more along w/ classic sx that include polydipsia, polyuria, polyphagia, frequent infections, and weight loss 2. Fasting glucose > 125 mg/dL on at least 2 occasions 3. 2-hr plasma glucose of 200 mg/dL or more after a 75g glucose load

Question 583

Bile acid sequestrants: effects

Answer 583

- vv LDL ** - ^^ HDL - no effect on TG

Question 584

Fibric acids: sfx?

Answer 584

1. Dyspepsia 2. Gallstones 3. Myopathy

Question 585

Fibric acids: name?

Answer 585

1. Gemfibrozil 2. Fenofibrate 3. Clofibrate

Question 586

What is the target LDL in a pt with a hx of CAD and at high risk for future cardiac events?

Answer 586

-70 mg/dL

Question 587

What are the recommendations for HTN screening?

Answer 587

-annual screening in all adolescents via bp measurements

Question 588

GLP-1 Agonists: MOA

Answer 588

-synthetic peptide that stimulates insulin release

Question 589

NY Heart Association Functional Classification of Angina

Answer 589

1. Class I = angina only with unusually strenuous activity 2. Class II = angina with slightly more prolonged or slightly more vigorous activity than usual 3. Class III = angina with usual daily activity 4. Class IV = angina at rest

Question 590

What is the first priority when treating a pt with a possible MI?

Answer 590

-getting an ECG and chest X-ray while giving meds to decrease damage to heart and to reduce bp = nitro and beta blockers

Question 591

GLP-1 Agonist: sfx

Answer 591

-nausea, vomiting, diarrhea, and acute pancreatitis

Question 592

What are the recommendations for Tdap?

Answer 592

-the childhood series, plus a booster at ages 11-12, and then once every 10 years after that

Question 593

What risks are present for a fetus of a diabetic mother as opposed to a fetus of a mother with gestational DM?

Answer 593

-fetal malformations bc the increased serum levels of glucose are present earlier in the pregnancy (5-10 weeks) during the critical organogenesis stages, versus gestational DM where the increased serum glucose usually doesnt occur until 20 weeks when the fetal organs have already formed

Question 594

What is the most common cause of HTN in children? What tests should be done?

Answer 594

- renal parenchymal dz | - tests: urinalysis, urine culture, and renal ultrasound

Question 595

Statins: contraindications

Answer 595

1. Active or chronic liver dz | 2. When pt is taking p450 inhibitor

Question 596

What is a dangerous sfx of metformin?

Answer 596

- lactic acidosis - the risk of lactic acidosis is increased by renal insufficiency - contraindicated in: women with creatinine > 1.4 and > 1.5 mg/dL in men, hepatic insufficiency, congestive heart failure

Question 597

4 Common Secondary causes for dyslipidemia?

Answer 597

1. DM 2. Hypothyroidism 3. Obstructive liver dz 4. Chronic renal failure

Question 598

Next step in therapy for unstable angina w/ possible MI that presents to ER?

Answer 598

"MONA" - Morphine = pain relief & decrease circulating catecholamines --> reduces hearts oxygen consumption - Oxygen - Nitro - Aspirin - plus: beta-blocker to reduce MI damage & GP IIb/IIIa inhibitors to reduce morbidity and mortality

Question 599

Sciatica

Answer 599

- pain along the path of the siatic nerve that radiates to the butt and the back of the thigh - usually caused by a herniated disk of the lumbar region of the spine

Question 600

Ddx for chest pain

Answer 600

See pg 233 of case files!

Question 601

What are 4 cancers that commonly involve the spine?

Answer 601

1. Multiple myeloma 2. Metastatic prostate cancer 3. Metastatic breast cancer 4. Metastatic lung cancer

Question 602

What is the oral drug of choice for DM?

Answer 602

-metformin!

Question 603

What is the target LDL range for a diabetic?

Answer 603

-70 to 100

Question 604

What is the primary tx for Parkinsons? What are some long term use sfx?

Answer 604

- levadopa, best for motor sx | - sfx: drug-induced dyskinesia and psychosis w

Question 605

What is the DASH diet plan high in?

Answer 605

1. Potassium | 2. Calcium

Question 606

What is spinal cord stenosis? Who is it commonly seen in?

Answer 606

- spinal canal narrowing that puts pressure on the spinal cord - can be congenital or acquired - more common in pts over 65 yrs old

Question 607

DPP-4 inhibitor: MOA? How is it used?

Answer 607

- ex. Januvia - inhibits DDP-4 = enzyme that inactivates incretin hormones like GLP-1 and GIP, which both stimulate the release of insulin from beta cells - Uses: 1. As monotx in pts that cant control DM with diet and exercise alone 2. In combo with metformin, sulfonylurea or thiazolidinedione as second-line tx