General Information

Question 1

Best evidence in a study?

Answer 1

1. Systematic reviews
2. Meta analysis
3. Randomized Clinical trials

Question 2

Geriatric with low Hgb, low serum iron, normal TIBC, Normal Ferritin, low MCV
Thx

Answer 2

Give Ferrous Sulfate oral TID and recheck in 1 and 3 months

Question 3

Patient oriented out come that should be discussed during shared decision making?

Answer 3

A decrease in all cause mortality

Question 4

True about Live attenuated intranasal influenza vaccine

Answer 4

It is more effective in age 2-6 than inactivated vaccine

Question 5

Alcohol management option supported by evidence

Answer 5

Chlordiazepoxide

Question 6

Confirm DX of Septic Shock?

Answer 6

High Lactate level

Question 7

Leading cause of death in RA PT

Answer 7

CAD

Question 8

68 y/o male, got PCV 23 at age 65. What vaccine to give now?

Answer 8

PCV 13

Question 9

Significant risk factor for Esophageal Adenoca

Answer 9

Obesity + GERD

Question 10

Lights criteria?

Answer 10

If exudate
Pleural fluid protein to serum protein >0.5
Pleural fluid LDH to serum protein >0.6
Pleural LDH >.67 time s the limit of normal

Exudates:
PE

Transudate: leaky

Question 11

Geriatric patient; what will affect pharmacokinetics?

Answer 11

Increase percentage fat!

Decrease lean body mass

Question 12

Bioterrorism that needs txt with 60 days of continues antibiotic?

Answer 12

Antrax!

TX with Fluroquinolones and Doxy

Question 13

HIV testing by USPTF?

Answer 13

Age 15 - 65

Question 14

ABI for Dvt

Normal?
Abnormal

Answer 14

1-1.4 is normal
>1.5 incompressible
<0.9 is abnormal

Question 15

When to screen for Hepatitis C

Answer 15

If patient was born bet 1945-1965

Question 16

Test for Hereditary Hemochromatosis?

Answer 16

Ferritin and Transferrin saturation

Question 17

USPSTF guidelines for 60 y/o Male who smoked for 20 yrs.

What do screen?

Answer 17

• Low dose chest CT!
• for age 55-80
• smoker or quit within 15 yrs
• 30 pack years

Other guidelines

• Screen for AAA if 65-75
• screen for Osteoporosis if Female > 65

Question 18

Hyperplastic Polyp less than 10 mm; when to rpt colonoscopy

Answer 18

In 10 yrs

Question 19

Labs of Vitamin B12 deficiency

Answer 19

Elevated Methylmalonic acid plus elevated Homocysteine

Question 20

Most common Carcinoma in the US?

Answer 20

Basal Cell Carcinoma

Question 21

Painless Ulcer in Labia, RPR negative.

How to confirm?

Answer 21

Rpt RPR!

- test becomes positive after 3 weeks from the appearance of the chancre

Question 22

Specificity vs Sensitivity

Answer 22

Specificity - ability to identify those who do NOT have the disease (good for screening)

Sensitivity - ability to identify those who have the disease(good for confirmatory)

Question 23

Patient with Celiac Disease. She is high risk for?

Answer 23

Osteoporosis

- decrease absorption of Ca and Vit D

Question 24

Non pruritic rash in the axilla; coral red flurescence on woods light
DX?

Answer 24

Erythrasma : Corynebacterium

Tx: Erythromycin or Clindamycin

Question 25

Best Diagnositic test for Vit D deficiency?

Answer 25

25- hydroxy vitamin D

Question 26

Best for Excercise induced Bronchospasm?

Answer 26

Albuterol + low dose corticosteroids

Question 27

Strategy to identify the unrecognized hep c is to screen what?

Answer 27

All born bet 1945-1965. Age 72- 92

Question 28

Most common neurological complications of Paget's?

Answer 28

Hearing loss

Question 29

Lyme disease. Most common cardiac problems?

Answer 29

HEART BLOCK --> TEMPORARY!

Question 30

Most common cause of medication related adverse events in the US?

Answer 30

1. Anticoagulants 2. Opioids 3. DM Meds

Question 31

Risk factor for Uncomplicated Cystis?

Answer 31

Frequent Sex

Question 32

``` 65 y/o female had bone density screening Low dietary Ca intake DXA showed -1.8 at hip and -2.1 at spine 10 yr risk of hip fx is 1.3% Mgt? ```

Answer 32

- Increase Ca to 1200mg/day and Vit D supplementation 800IU | * if 10 yr risk of hip fx is >20%, may do Alendronate, or Calcitonin-Salmon

Question 33

CT scan is equivalent to how many CXR?

Answer 33

400

Question 34

Patient with menorrhagia | What will be consistent with von Willebrand?

Answer 34

- prolong PTT | * coagulation disorder; decrease protein complex of platelet adhesions, hence Platelets should be normal

Question 35

36 y/o male with episodic rectal pain Every 3- 6 months; sharp severe, cramp like 1-15 mins; normal anoscopy and DRE DX?

Answer 35

Proctalgia fugax

Question 36

18 y/o with intensely pruritic papular eruption in the waist after walking in the woods PE: excoriated papules along the belt line Cause of rash?

Answer 36

Chiggers - mite larvae - crawl until they reach constrictive clothing like belt and socks

Question 37

Patient how is 200 lbs ABOVE her ideal wt. | Which wt loss treatment will decrease her cardiac risk?

Answer 37

1. Bariatric surgery! - reduce all cause mortality | * Orlistat and Phentermine will have moderate wt loss but no decrease in morbidity and mortality

Question 38

Most prevalent form of elderly abuse

Answer 38

Financial exploitation

Question 39

Chronic fatigue syndrome Components? Symptoms that rules it out?

Answer 39

1. 6 months of pathologic fatigue ,unrefresh sleep ,impairment of focus and concentration ,ORTHO static intolerance ,post exertional malaise + tender lymph nodes 2. Not in Chest pain, Neuro deficits, enlarged LN, Joint erythema

Question 40

What physiologic change do you expect in the elderly in terms of BP?

Answer 40

WIll have widen pulse pressure The DBP will decline PP= SBP - DBP

Question 41

60 y/o male with DDD | Herbal supplement that may be beneficial?

Answer 41

S-adenosine L- Methionine

Question 42

90 year old schedule for surgery | What test to assess frailty?

Answer 42

Gait speed | Frailty: age related ; multidimensional state of decreased physiologic reserves

Question 43

Patient with Irritable bowel syndrome | Therapy to reduce abdominal cramping?

Answer 43

Peppermint oil! - has antispasmodic properties

Question 44

Drug noted to beneficial for a common disease Cheap, generic, no pharma firm willing to fund a trial What type of study is good to evaluate this treatment?

Answer 44

A Non -inferiority trial: does not distinguish that a new drug is not inferior or superior

Question 45

46 y.o male with ADPCKD with HTN.Meds?

Answer 45

ACE!

Question 46

Patient wants to manage HTN non pharmacologic. Recommendation? How much salt? How much wine?

Answer 46

Monitor home BP Salt 2400mg/day = 1 tsp of table salt 2 drinks of wine/day for men and 1 drink for women

Question 47

Greatest benefit of Bariatric surgery

Answer 47

- remission of type 2 dm | - decrease all cause mortality

Question 48

Mosquito repellent safe for pregnant?

Answer 48

DEET 35% insect repellents Oil of lemon eucalyptus is comparable to DEET but not advised for pregnant or children age less than 3 Citronella- not for disease carrying mosquitoes