PAeasy practice test Flashcards
20 year old female with hypothyroidism and OCP use, she has hypertension. what type is it?
secondary - estrogen use
causes of secondary hypertension
genetic causes, renal diseases, hyperaldosteronism, Cushing syndrome, pheochromocytoma, coarctation of the aorta, pregnancy, thyroid or parathyroid disease, and estrogen use
sore throat, muffled voice and pain radiating to the ipsilateral ear are signs of what?
peritonsillar abscess - also drooling, trismus, deviated uvula
treatment of bacterial conjunctivitis in a 6 year old
Azithromycin 1% ophthalmic solution, one drop in the affected eye twice daily for three days
(want something that has limited dosing. polymixinB/trimethoprim dosed 4 time daily isnt convenient)
what is uterine procidentia
aka complete uterine prolapse : Herniation of three (anterior, posterior and apical) pelvic compartments through the vaginal introitus
what are the old and new systems used to grade pelvic organ prolapse?
old: balden walker
new: “POP-Q”
how is the “pop-Q” system scored?
Stage 0 no prolapse is demonstrated (at ischial spines)
Stage 1 1+ cm above the hymen
Stage 2 the most distal portion is 1 cm or less proximal or distal to the hymenal plane
Stage 3 : 1 + cm below hymen but not ALL vagina has prolapsed
Stage 4 vaginal eversion is essentially complete
UA culture shows sensitivity to nitrofurantoin, can you treat the pyelonephritis with this?
no, b/c nitrofurantoin does not penetrate to the kidneys. need ciprofloxacin or levofloxacin. also can do bactrim.
best drug for acute migraine treatment?
sumatriptan, but best when taken in prodrome.
pelvic organ prolapse in anterior (cystocele) or posterior chamber (like a rectocele) needs what kind of treatment?
colporrhaphy with plication of the anterior endopelvic fascia or rectovaginal fascia
treatment for apical (middle) compartment pelvic organ prolapse ?
Uterosacral ligament suspension or sacral colpopexy
acute mitral regurg from papillary muscle rupture after MI presents with what two symptoms?
pulmonary edema and a systolic murmur.
murmur of aortic insuficiency
high-pitched, blowing diastolic murmur heard best at the left sternal border.
postmyocardial infarction syndrome aka ?
dressler syndrome - post-MI pericarditis
treatment options for mallet finger: conservative vs surgical decisions?
conservative:Place the patient in a STAX splint for six weeks and restrict DIP motion (leaves PIP joint free)
Sx: for large bone fragments, joint subluxion, or complex open injuries.
at what age should the majority of males have palpable testes? how do you find it?
6mo - if not found, attempt to palpate a retractile or undescended testis by sweeping one hand along the anterior iliac spine with the other hand at the scrotum until the testis is pushed into a position where it can be examined.
TPA absolute contraindications (5 general categories)
- head Sx, trauma, stroke or bleeding in past 3 mo
- known brain mass/aneurysm/AV malformation
- active internal bleed, bleeding condition
- uncontrolled HTN
- abnormal blood glucose,
In an adult with low back pain who presents for evaluation, which of the following is most consistently associated with a risk for malignancy in the United States? Hx of CA or weight loss?
HX of CA
first and second line txt for Cdiff
- vancomycin 2. metronidazole
MC cause :sudden onset of target-shaped lesions on the extensor surfaces of the arms and palms of the hands. They are asymptomatic.
erythema multiforme: HSV
* can also be caused by mycoplasma
sulfa and PCN drugs
MOST important primary prevention for recurrence of skin cancer
sun safe behavior (over yearly physicals)
Txt of HIT?
treatment should not be delayed while awaiting lab results. All forms of heparin, including unfractionated heparin, should be immediately discontinued and an alternative anticoagulant (thrombin inhibitor) should be initiated.
plt transfusion for HIT?
*A platelet transfusion should be avoided in most cases, unless acute bleeding is present.
steps to Dx asthma in acute onset of symptoms in primary care office
- oxygen saturation check
- If low, a nebulizer would be the next most likely step
- Definitive diagnosis requires spirometry once the patient is known to be stable
biggest risk factors for urinary stress incontinence?
- age
2. vaginal childbirth
what imaging is used for screening for AAA?
ultrasound
staging of AC joint injuries (type 1-3 and the corresponding recommendations for time to return to play). which types need ortho referral?
I- stretched (sprained) AC ligament. 3days -2wks
II- torn AC, sprained CC. 2-4wks
III- torn AC, torn CC. 6-12 wks
type II + need ortho referral
initial treatment for anterior epistaxis
- direct pressure- tamponade
2. chemical cauterize/thrombogenic foam/ balloon
suspected third interspace Morton’s neuroma, which treatment modality in primary care is associated with the best outcome?
steroid injection (+/- cause permanent numbness) - only 30% success rate
- Sx if failed.
- orthotic pads have little proven benefit
screening guidelines for gestational DM
- universal screening for overt diabetes (not gestational) at the initial prenatal visit in all patients by checking A1C; a diagnosis of overt diabetes is made when A1C is ≥6.5 percent
- 24-28wks
two step: nonfasting 50gram 1hr test >140 –> fasting 3hr 100gram GTT (fasting >95, 1hr >180, 3hr >140)
one step: fasting 75gram 2hr test
txt options for gestational DM, risk of 2nd line?
best - insulin
2. glyburide (risk of eclampsia)
sugar goals fasting and post prandial for Gestational DM
goal fasting <95, post prandial <120
labor induction for gestational DM: uncontrolled DM/macrosomia vs controlled/no macrosomia
uncontrolled: 38 wks
controlled: 40wks
Dx and treatment of mild diverticulitis symptoms ?
no labs or CT needed. clear liquids +/- abx (cipro or bactrim + metronidazole)
pain with mortons neuroma
lancinating (Stabbing) MC third metatarsal digit space, radiating to toes on either side.
A 13-year-old male presents to your clinic with a two-week history of a painful, enlarging mass in his right mid-shaft tibia. - what is the likely bone mass?
ewing sarcoma
(osteoid osteoma is not associated with a mass, osteoid sarcoma is found at metaphysis, myosarcoma is found in large muscles)
vaccines reccomended for 65yo+?
pneumoccocal 23 and 13, up to date on Tdap and flu.
causative organism and treatment for erysipelas
strep pyogenes + PCN
Dx of lactose intolerance
hydrogen breath test (after trial of lactose free diet)
dermatitis herpetiformis is common in what disease?
celiac dz (sprue) - itchy, papulovesicular all over body
Dx celiac dz
endomysial IgA Ab and transglutaminase Ab
definitive = small bowel biopsy
ogilvie’s syndrome
colonic pseudoobstruction (acute dilation without mechanical obstruction). MC cecum and right hemicolon. MC after surgery, old, meds, etc
3 options for txt for ogilvies syndrome
conservative (IV fluids/electrolytes), neostigmine, NG suction/enema decompression
what is neostigmine and what is it used for?
parasympathomimetic that acts as acetylcholinesterase inhibitor (so increases Ach) - txt for myasthenia gravis, ogilvies syndrome, urinary retention
best drugs to decrease mortality of HF, how do you choose which?
- ACE-Is
- ARB (if unable to tolerate ACE)
- BBs (carvedilol, metoprolol, bisoprolol) - used in addition to or if CI for ACEs/ARBs
ADRs and CI for ACE-Is in HF?
ADR: cough, angioedema, hypotension w/ first dose, hyperK, renal insufficiency (esp
at what GFR and/or serum Cr is dialysis indicated?
GFR <10 or Serum Cr >8
vulvar itching and pain for “months.” On exam, the vulva appears moist with raised, erythematous demarcated plaques. A few of the plaques are ulcerated. When acetic acid is applied, the lesions are more distinct with white epithelium. Which of the following is most appropriate?
colposcopy with Bx - concern for vulvar intraepithelial neoplasm (VIN)
what ultrasound finding is consistent with intussusception
target sign
hypertension, headache, sweating, palpitations, anxiety with a sense of impending doom, and tremor. Dx = ?
pheocromocytoma
txt of pheocromocytoma?
treat HTN w/ CCBs or alpha blockers
need BP control before tachycardia control with BBs
finger caught in car door, intact neurovascular to the distal tip, but nail bed laceration with active bleeding. Which of the following statements represents acceptable standard of care for this injury?
Nail must be removed and the nailbed repaired with an absorbable small gauge suture (6-0).
*unstable/ neurovascular compromise = ortho referral
permission to perform a new prodcedure must be documented in what legal document?
Your credentialing/privileging agreement
when is elective cesarean delivery indicated with placenta previa? why not induce labor?
between 36 and 37 weeks gestation if < 2cm from the os
induction of regular labor puts patient at risk of abruptio placenta and bleeding
txt for rosacea?
- Abx- metronidazole or clindamycin
NOT steroids
hyphema (blood in the anterior chamber) will result in what other eye abnormalities?
increased intraocular pressure and decreased visual acuity
What is your best serology test to monitor treatment for infected skin wound?
CRP (rises with acuity of infectious/inflamm process and falls with treatment)
-CBC and blood cultures are good for initial eval and choosing treatment
what lab values are essential to making the diagnosis of diabetic ketoacidosis? (blood glucose level, pH, bicarb, ketones?)
Essential to making the diagnosis is a blood sugar > 250mg/dL, acidosis (pH < 7.3), bicarbonate < 15 mEq/L, and positive serum ketones
*also hyperK+ helps
______ refers to the ethical concept of treating everyone in a fair manner
justice
In a patient with known idiopathic pulmonary fibrosis, which medication to improve the patient’s cough?
thalidomide (immunomodulator - works anti-inflamm)
NOT steroids
what percent of lyme Dz patients have erythema migrans?
~75%
ASD vs PSD murmur
ASD: early ejection systolic murmur with a wide split of the second heart sound.
VSD: pansystolic murmur.
tetralogy of fallot murmur
harsh systolic murmur and a single second heart sound
screening and test for excessive growth hormone
random serum IGF-1, if elevated –> oral glucose challenge test then measure serum growth hormone in 1 hr, acromegaly + is >1 ng/mL
txt for chalazion ?
warm compress (NOT I+D unless refractory or recurrent)
Dx for symptomatic lyme disease (<1month vs >1 month)
EIA and Western blot testing are recommended initial testing, EIA plus western blot -IgM and IgG for less than four weeks, and Western blot alone for more than four weeks
pt w/ PNA from southwest US txt? (healthy vs high risk
inhalation for coccidiomycosis/valley fever spores (fungus)
- healthy: supportive care
- severe dz/immunocomp/pregnant: antifungal (fluconazole)
txt for acute gout flares vs prevention/chronic gout
acute: NSAIDs (indomethacin), colchicine +/- steroids
chronic: allopurinol, febuxostat, probenecid
what type of fluid is used to resuscitate hypovolemic shock?
isotonic crystalloid(0.9% NS or lactated ringer) NOT hyper or hypotonic solution, or colloid
what patient populations are at higher risk for flu complications (comorbidities, age, ejection fraction, pregnancy status)
DM, >65, EF <50% (indicated HF or cardiomyopathy), currently pregnant
acute vomiting, RLQ pain, WBC > 15,000, temp >101, elevated ESR - which of these most indicate a pt has appendicitis?
WBC >15,000
- according to appendicitis inflamm response score, WBC this high contributes the most points. vomiting, pain, temp and CRP (not ESR) also included
On review of the EKG, which finding will differentiate atrial fibrillation from atrial flutter?
irregular QRS response - Afib
regular - Aflutter
(both have narrow QRS, immeasurable PR and varying rate)
which of the following test is most helpful in diagnosing an acute anterior cruciate rupture? (lachman or anterior drawer)
lachman
possible water breaking you do a nitrazine test, what is the pH of amniotic fluid vs vaginal?
amniotic >7 , normal vaginal ~4
Hx of rheumatic fever and murmur:a diastolic rumble murmur with an opening snap is appreciated at the apex of the heart in the left lateral decubitus position.
mitral stenosis
murmur of mitral valve prolapse
mid-systolic click, followed by a late systolic murmur best identified at the apex.
A positive predictive value is defined as which one of the following statements?
Percentage of people with a positive test who have disease
The ability of a test to correctly identify patients with disease = ?
sensitivity
Which of the following structures is most commonly adversely affected in hypertrophic cardiomyopathy (HOCUM)?
left ventricle (not septum)
high resolution CT is used for what?
lung abnormalities (not abdominal - which is just CT abdomen w/ or w/out contrast)
Typically, a normal intra-uterine pregnancy will have a hCG double over __ hrs, what does abnormally rapid rise indicate?
48-72 hours
abnormal (high) rise may indicate ectopic
The presence of which positive serologic markers would be found in a patient with a resolved acute HBV infection?
Anti-HBc IgG and Anti-HBs
_______ appears during acute hepatitis B but persists indefinitely
IgG anti-HBc
________ appears after clearance of HBsAg and after successful vaccination against hepatitis B
anti-HBs
what symptoms can help differentiate meineire’s from labrynthitis
meneires: N/V
To distinguish folate deficiency from vitamin B deficiency, which lab(s) should be ordered?
Homocysteine and methylmalonic acid
folate deficiency anemia: homocysteine level is elevated vitamin B12 deficiencies: both are elevated
solitary thyroid nodules, fine needle aspiration biopsy is indicated for nodules larger than____ diameter with a suspicious appearance on ultrasound (i.e. solid, irregular)
0.5 cm
level of eval and mgmt for patient problem: how is “comprehensive” and “detailed” different from problem focused and expanded problem focused
detailed: includes pertinent family and social Hx
comprehensive: includes complete FHx and SHx
MC causative organism for otitis externa?
Pseudomonas aeruginosa
how do symptoms of MS change with pregnancy?
Often, symptoms of MS improve during pregnancy and worsen after delivery.
first line option for treatment of seborrheic keratosis
cryotherapy
txt protocol for postpartum hemorrhage due to uterine atony
- rapid infusion of oxytocin
- bimanual massage
- activation of emergency protocols (i.e., OB alerts, fluid initiation, transfusion protocol, etc.)
- uterotonic administration (ergonovine maleate, carboprotost, and misoprostol)
- if failure…Balloon tamponade and uterine artery embolization
S+S aortic aneurysm vs dissection
dissection = sudden/severe abdominal pain (but not always “tearing”), discordinant pulses, HTN
symptoms of ASD- what are they like and what age do they come up?
Many patients with ASD are asymptomatic at birth. Exertional dyspnea or heart failure may develop, most commonly in the fourth decade of life or later.
delivery of baby + shoulder dystocia: what maneuvers are suggested and which are CI?
accepted: mcRoberts, delivery of posterior arm, zavanelli maneuver)
CI: fundal pressure
best imaging Dx for pericardial effusion
echocardiogram
Face presentation (head is hyperextended) in a term nulliparous woman where the mentum (fetal chin) is posterior - what is reccomended?
cesarean delivery
Which of the following conditions is associated with posterior blepharitis?
Keratoconjunctivitis sicca (dry eye syndrome from meibomian gland dysfxn aka posterior belpharitis
interstitial lung disease (such as silicosis) has increased risk of what other sequelae?
other autoimmune d/o and tuberculosis
primary care mgmt of clavicle fracture? (sling, figure 8, urgent ortho consult? )
sling (figure 8 increases risk of necrosis )
urgent ortho consult reserved for open fracture and neurovascular compromise
