Missed Questions Flashcards
What is the most common cause of death following bariatric surgery?
Pulmonary embolus
In the elderly, levothyroxin replacement should be started at what percentage of the starting dose in the non-elderly adult patient?
60 to 75%
Which oral medication is most effective in lowering postprandial blood sugars?
Exanatide or Byetta
What is the definition of TIA?
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.
What is the antibiotic of choice for empiric treatment of asymptomatic bacteria in a pregnant woman?
Cephalexin
Of the following list, which is the greatest risk factor for premature onset of labor?
Concurrent STD, low socioeconomic status, uterine anomaly, and history of mid second trimester spontaneous loss of pregnancy.
Concurrent STD
A patient has sleep apnea, leg swelling, a BMI of 44.1, a respiratory rate of 12, a blood pressure of 120/78, and O2 sat of 86% on room air, with normal EKG and chest x-Ray. Pulmonary function testing shows a restrictive pattern. abnormal blood tests include only a significantly elevated bicarbonate level.
Which of the following treatments has been shown to be likely to reduce this patient’s mortality rate? ACE inhibitors, nebulized albuterol, CPAP or BiPAP, high-dose diuretics, or continuous oxygen therapy
CPAP or BiPAP
Note: this patient has Pickwickian syndrome with chronic daytime hypoxia and carbon dioxide retention.
What are some of the risks and benefits of vacuum assisted deliveries?
Vacuum assisted delivery has higher rates of neonatal cephalohematoma and retinal hemorrhage compared with forceps delivery. Vacuum assisted delivery is associated with less maternal soft tissue trauma when compared to forceps delivery. Compared to spontaneous vaginal delivery, the likelihood of severe perineal laceration is increased. Both forceps and vacuum assisted delivery are associated with an increased risk of shoulder dystocia and it is higher in vacuum assisted delivery.
What is the most effective method to assist a patient in smokeless tobacco cessation?
Behavioral interventions. Mint snuff as a substitute and medications have not been shown to be effective including nicotine team patches or gum.
Which of the following antidepressants would be most appropriate for an elderly man with decreased appetite and insomnia and depression: nortriptyline, bupropion, amitriptyline, mirtazapine , or trazodone?
Mirtazapine. It has serotonergic and not nor adrenergic properties and is associated with increased appetite and weight gain it may be particularly useful for patients with insomnia and weight-loss. Trazodone maybe useful but as it is not recommended as a primary antidepressant because it causes sedation and orthostatic hypotension at therapeutic doses.bupropion would aggravate his patients insomnia. Tricyclics are no longer considered first-line treatments because of their side effects,including cardiotoxicity.
What is the most appropriate advice for a patient who has passed six calcium oxalate stones over the past four years?
The patient should follow a low sodium, restricted-protein diet with increased fluid intake. Oxalate restriction is also helpful which means restriction of foods such as spinach, chocolate, tea and nuts. Potassium citrate should be taken at meals to increase urinary pH and urinary citrate.
What are appropriate treatments for benign essential tremor?
Beta blockers or primidone.
What is the appropriate treatment for 23 month old child with a two day history of fever to 102° F, cough, wheezing, mildly labored breathing, and no response to aerosolized bronchodilator?
This is a typical case of bronchiolitis. Bronchodilator treatment maybe tried once and discontinued if there is no improvement. Treatment usually consists of supportive care only, including oxygen and IV fluids if indicated. Steroids, antibiotics and decongestants are of no benefit.
Lumbar spine stenosis will typically cause increased pain in the lower limbs with what activities?
Spine extension and walking downhill. The pain is typically improved with spine flexion, walking uphill and sitting.
What are the most common pathogens in previously untreated acute superficial foot infections in diabetics?
Aerobic gram-positive staph aureus and beta-hemolytic streptococcal groups A, B, and others.
A 67-year-old male has a 0.5 cm adenomatous polyp with low-grade dysplasia found on screening colonoscopy. When should the next colonoscopy done?
According to the multi society task force on colorectal cancer, patients with one or two small, (i.e. less than 1 cm) tubular adenomas, including those with only low-grade dysplasia, should have their next colonoscopy in 5 to 10 years.
What are the clinical features a posterior tibial tendinopathy? What is its treatment?
It is most commonly seen in women over the age of 40. the patient usually recalls no trauma although the injury may occur from twisting the foot by stepping in a hole. There is pain and swelling and tenderness posterior to the medial malleolus. With the patient standing on tiptoe the heel does not deviate in varus alignment as it should. A single toe raise should reproduce the pain.
Over time this injury can elongate the midfoot and hindfoot ligaments, causing a painful flatfoot deformity. Treatment should be immobilization in a cast boot or short leg cast for 2 to 3 weeks.
What test is the best predictor of vancomycin efficacy?
Trough serum levels.
What metabolic abnormality is very likely to be seen in patients with stage four kidney disease?
Hyperparathyroidism. Current guidelines recommend monitoring calcium and phosphate every 3 to 6 months, and bone specific alkaline phosphatase every 6 to 12 monthso in these patients.
In a patient with suspected diarrhea predominant irritable bowel syndrome, what test should always be performed to rule out another disease?
Testing for celiac disease. About 4% of people with diarrhea predominant or mixed presentation irritable bowel syndrome have biopsy-proven celiac disease.
