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Old Exam Notes Flashcards
Screening method for lung cancer?
Low-dose CT
Best way to screen for alcohol
Cage
At what age should low risk men be screened for colon cancer and when to repeat
50 and repeat after 10 years
When to stop screening for cervical cancer?
65 years
Remember staph auerus causes which type of ear infection
Externa
Sleep diary is good for sleeping disordres
.
Disk prolapse: old - lifting heavy item - radiating pain to the thigh - can’t lift his feet from ground.
.
Lateral epicondylitis: lateral elbow pain with hammar use
.
Unable to dorsiflex great toe and loss of sensation in the medial foot: L5
.
Alcohol is not a risk factor for MI
,
Low iodine uptake are usually due to:
- thyroiditis
- factitious
- exogennus thyroid medciations\ectopic
.
Salmonella can cause diarrhea.
.
There is insufficient evidence to recommend for or against BSE “breast self examination”
.
You are concerned that one of your 65-year-old patients is developing dementia. Which of the following, if present, would lead you to suspect dementia rather than delirium or depression?
a. Acute onset of symptoms
b. Difficulty with concentration
c. Signs of psychomotor slowing
d. Good effort with testing, but wrong answers
e. Patient complaint of memory loss
D
You are caring for a 69-year-old woman with symptoms suggesting Alzheimer disease. Which of the following clinical features of Alzheimer disease is most likely to remain intact until the late stages of the disease?
a. The ability to recall new information
b. Word-finding ability
c. The ability to draw complex figures (intersecting boxes or a clock)
d. The ability to calculate (balance a checkbook)
e. Appropriate social behavior
E
use donepezil (Aricept), and begin therapy. With respect to disease progression, which of the following statements best describes donepezil’s effect on AD?
a. It dramatically slows the progression of neurodegeneration.
b. It modestly slows the progression of neurodegeneration.
c. It has no effect on the progression of neurodegeneration.
d. It modestly increases the progression of neurodegeneration.
e. It dramatically increases the progression of neurodegeneration.
C
You are seeing an 82-year-old patient with moderately advanced AD. His wife is his primary caregiver and reports that he has had increasing behavioral symptoms over the last 6 months; he paces constantly, is often agitated, and lately, has been resisting the home health worker’s care. Despite optimizing nonpharmacologic measures, he has become difficult for her to manage and she would like for you to prescribe something to help with his aggressive behavioral symptoms. He currently takes only blood pressure medication and a statin. Which of the following would be the best initial choice for this patient?
a. Donepezil
b. Sertraline
c. Carbamazepine
d. Memantine
e. Risperidone
A
“Start donepezil first then if it doesn’t work go for respirdone”
You are evaluating a 36-year-old obese woman who complains of fatigue. She denies polydipsia, polyuria, polyphagia, or weight loss. Which of the following laboratory reports confirms the diagnosis of diabetes?
a. A random glucose reading of 221 mg/dL
b. A random glucose reading of 221 mg/dL, and another, on a later date, of 208 mg/dL
c. A fasting glucose measurement of 128 mg/dL
d. A glucose reading, taken 2 hours after a 75-g glucose load, of 163 mg/dL
e. A hemoglobin A1C of 6.3%
C
“Remember, you can’t use RBG to diagnose if there is no symptoms”
An 18-year-old morbidly obese patient in your office is found to have a fasting glucose of 314 mg/dL. Which of the following test results would indicate that he is a type 1 diabetic?
a. Low levels of C-peptide
b. Markedly elevated levels of C-peptide
c. Elevated levels of microalbumin in the urine
d. A markedly elevated hemoglobin A1C
e. The presence of parietal cell antibodies
a
You are managing a 36-year-old woman with a new diagnosis of T2DM. Past medical history includes depression, venous insufficiency, and gestational diabetes with each of her pregnancies. Her fasting plasma glucose is 287 mg/dL, the remainder of her metabolic panel is normal, and her hemoglobin A1C is 9.2%. Urinalysis is normal, but her albumin-to-creatinine ratio is elevated. She has no previous evidence of kidney disease. Her BMI is 33 kg/m 2 and her blood pressure is 128/76. She denies any symptoms of hyperglycemia, including polydipsia, polyphagia, or blurred vision.
What is the most appropriate first course of action for this patient?
a. Admit her to the hospital and start an insulin drip and replace electrolytes as needed
b. Start metformin 1000 mg twice daily
c. Start insulin glargine 0.2 U/kg/d
d. Start metformin and a glucagon-like-peptide 1 (GLP-1) receptor agonist
D
You are managing a 36-year-old
woman with a new diagnosis of T2DM. Past medical history includes depression, venous insufficiency, and gestational diabetes with each of her pregnancies. Her fasting plasma glucose is 287 mg/dL, the remainder of her metabolic panel is normal, and her hemoglobin A1C is 9.2%. Urinalysis is normal, but her albumin-to-creatinine ratio is elevated. She has no previous evidence of kidney disease. Her BMI is 33 kg/m 2 and her blood pressure is 128/76. She denies any symptoms of hyperglycemia, including polydipsia, polyphagia, or blurred vision.
At this time, how would you address this patient’s positive microalbumin screen?
a. Initiate therapy with an ACE-inhibitor
b. Initiate therapy with an ARB
c. Prescribe a low-protein diet
d. Optimize glycemic control and repeat screening
e. Refer to endocrinology
D
You are seeing an African-American man with newly diagnosed diabetes. His blood pressure at the last visit was 148/76 mm Hg, and at this visit it is 152/82 mm Hg. He has no evidence of CVD or CKD and is not on any antihypertensive agents. Which of the following statements is true regarding the use of an ACE-inhibitor in this patient?
a. An ACE-inhibitor should be added to his regimen because he is diabetic, regardless of his blood pressure.
b. An ACE-inhibitor is the preferred agent to be added to his regimen based on his blood pressure readings.
c. An ACE-inhibitor should not be added to his regimen unless his blood pressure goes above 160 systolic.
d. An ACE-inhibitor should not be added to his regimen unless he has microalbuminuria.
e. An ACE-inhibitor should not be given to this patient if his creatinine is elevated.
D
In the prenatal workup for one of your patients, you discover she is rubella nonimmune. When is the best time to vaccinate the patient against rubella?
a. Immediately
b. In the second trimester of pregnancy
c. In the third trimester of pregnancy
d. In the early postpartum period
e. At least 4 weeks postpartum
D
You are examining a normal term newborn whose mother is hepatitis B virus surface antigen positive. Which of the following protocols is recommended for the child?
a. Hepatitis B vaccination at 0–2 months, a second dose at 1–4 months, and a third dose at 6–18 months of age
b. Hepatitis B vaccination within 12 hours of birth, with the timing of the second and third doses based on the mother’s Hepatitis B viral load at the time of delivery
c. Hepatitis B vaccination and hepatitis B immune globulin within 12 hours of birth, a second dose of hepatitis B vaccine at 1–2 months, and a third dose of vaccine at 6 months
d. Hepatitis B vaccination and hepatitis B immune globulin within 12 hours of birth, a second dose of the vaccine and immune globulin at 1–2 months, and a third dose of the vaccine and immune globulin at 6 months
e. Hepatitis B vaccination at birth, with serologic testing of the baby before additional vaccinations are given
C
A 44-year-old African American with T2DM transfers care to you. Reviewing her records, you find she is on the maximum dose of metformin and her hemoglobin A1C is
- 0%. Review of her baseline laboratory tests reveals normal liver enzymes and a creatinine of
- 3 mg/dL (GFR 35 mL/min/1.73 m2 ). Her BMI is 26 kg/m2 . She is hypertensive and is well controlled on a thiazide diuretic and an ACE-inhibitor. Which of the following management options would be the most beneficial?
a. Continue the current regimen
b. Add glyburide
c. Discontinue the metformin and add linagliptin
d. Discontinue the metformin and add dapagliflozin
e. Add sitagliptin
C
You are seeing a 26-year-old male patient complaining of a red eye who says, “I think I have pink eye.” He reports redness, irritation, tearing, watery discharge, and fairly intense eye pain. Which of his reported symptoms is more suggestive of something other than conjunctivitis?
a. Redness
b. Irritation
c. Tearing
d. Discharge
e. Pain
E
You are caring for a 21-year-old college junior who comes to see you for a red eye. He noticed the problem after waking up this morning, and it caused him significant concern. He denies eye pain, loss of vision, discharge, or trauma. He has never had an episode like this before. He reports that he was very ill yesterday with nausea and intense vomiting for several hours, but is feeling better today. On examination, you note a localized and sharply circumscribed bright red patch on his left eye. Which of the following statements is true?
a. Trauma is the likely cause.
b. Underlying hypertension is the likely cause.
c. An unrecognized bleeding disorder is the likely cause.
d. Increased intrathoracic pressure is the likely cause.
e. Referral to an ophthalmologist is indicated.
D
“Due to intrathoracic pressure”
You are seeing a 4-year-old boy whose mother brought him in to be assessed. He’s been irritable and feverish for 3 days, with runny nose, slight cough, and ear pain. Today, he woke up with bilateral eye redness and discharge. After evaluation and examination, you diagnose otitis media and bilateral conjunctivitis. You are treating his otitis media with high-dose amoxicillin therapy. Which of the following is true regarding treatment of his conjunctivitis?
a. No additional treatment is necessary.
b. Treatment with a topical antibiotic ophthalmologic solution is indicated.
c. Treatment with a topical antibiotic ophthalmologic ointment is indicated.
d. Treatment with a topical antiviral ophthalmologic solution is indicated.
e. Treatment with a topical corticosteroid is indicated.
A
One of your patients has been on β-blocker therapy for migraine prophylaxis. Her symptoms are not controlled and she is interested in trying another prophylactic medication. Which class of antidepressants has the strongest evidence base for prophylactic use in migraines?
a. Tricyclic antidepressants
b. SSRIs
c. Monoamine oxidase inhibitors (MAOIs)
d. Selective norepinephrine reuptake inhibitors
A
You are talking with a 24-year-old woman complaining of a headache. She reports that before she has the headache, she experiences visual symptoms associated with slight nausea. When the headache occurs later, it is throbbing, pulsating, and unilateral. During the headache, she experiences light sensitivity. Sleep improves the symptoms. Her symptoms are disrupting her daily life, and you decide to try prophylactic therapy. Which of the following prophylactic agents has established efficacy data to support its use?
a. Propranolol
b. Amitriptyline
c. Fluoxetine
d. Gabapentin
e. Clonazepam
A
In the evaluation of a 55-year-old man complaining of dizziness, you perform the DixHallpike (Nylen-Barany) maneuver several times. You had the patient sit on the edge of the examining table and lie down suddenly with the head hanging 45 degrees backward and turned to either side. With this maneuver, the vertigo was reproduced immediately and symptoms did not lessen regardless of repetition. The direction of the nystagmus changed with changing the direction that the head is turned, and the symptoms were of mild intensity. Which of the following is the most likely cause of the vertigo?
a. Stroke
b. Vestibular neuronitis
c. Benign positional vertigo
A
In BPV the symptoms should take couple of seconds before they occur, and nystagmus should be fixed
A 42-year-old woman is seeing you to follow-up with a new complaint of “dizziness.” She reports that symptoms first began several months ago. At that time, she reported a subjective hearing loss and a ringing in her left ear only. Symptoms were mild, and her physical examination was normal, so you elected to follow her. Since that time, her symptoms have progressed to include dizziness and some facial numbness. Which of the following is her most likely diagnosis?
a. Vestibular neuronitis
b. Benign positional vertigo
c. Acoustic neuroma
d. Meniere disease
e. Cerebellar tumor
C
“I just added this questions because i thought it was minnere disease but appearantly there should be Nasuea and vomitting”
His mother brought him to see you because the daycare will not take him back until he’s had a doctor evaluate his eye symptoms. He developed an acute redness of the left eye, associated with runny nose, cough, and increased irritability. On examination, his eye is red and watery. The discharge is clear, and he has mild eyelid edema. Which of the following is the most common cause for his condition?
a. Coxsackie virus
b. Parainfluenza virus
c. Adenovirus
d. Rhinovirus
e. Herpesvirus
C
- The most common cause of bacterial conjunctivitis in American adults is
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Chlamydia trachomatis
D) Staphylococcus aureus
E) Klebsiella
D
Which one is tertiary prevention:
B) Purified protein derivative determination in a patient who is affected with tuberculosis
C) Smoking cessation counseling in a patient who is known to have chronic obstructive pulmonary disease
D) Administration of erythromycin eye drops to neonates
E) Hepatitis A vaccination for travelers
C
A 12-year-old boy presents with eye itching and redness. He has clear drainage from his eyes but no crusting. Examination today is normal except for mildly injected conjunctiva bilaterally. Which of the following is the most appropriate treatment?
A. Antibiotic eye drops
B. Ophthalmology consultation
C. Anti-inflammatory eye drops
D. Oral leukotriene inhibitor
C
“Also mentioned that oral and topical antihistamines are indicated if it was there in the answer”
A 56-year-old man presents to his physician with symptoms consistent with allergic rhinitis. His past medical history is positive for benign prostatic hyperplasia. He continues to work in a warehouse as a forklift operator. Which of the following medications should be used to treat this patient?
A. Diphenhydramine
B. Hydroxyzine
C. Chlorpheniramine
D. Fexofenadine
D
“Because it’s 2nd gen antihistamine that has less sedative effecT”
Diagnosis of corneal abrasions can best be accomplished in a family physician’s office with
A) Fluorescein dye examination
B) Slit-lamp examination
C) Handheld ophthalmoscope
D) Visual field testing
E) Schiøtz’s tonometer
A
