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PAeasy practice test Flashcards

1
Q

20 year old female with hypothyroidism and OCP use, she has hypertension. what type is it?

A

secondary - estrogen use

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2
Q

causes of secondary hypertension

A

genetic causes, renal diseases, hyperaldosteronism, Cushing syndrome, pheochromocytoma, coarctation of the aorta, pregnancy, thyroid or parathyroid disease, and estrogen use

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3
Q

sore throat, muffled voice and pain radiating to the ipsilateral ear are signs of what?

A

peritonsillar abscess - also drooling, trismus, deviated uvula

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4
Q

treatment of bacterial conjunctivitis in a 6 year old

A

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)

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5
Q

what is uterine procidentia

A

aka complete uterine prolapse : Herniation of three (anterior, posterior and apical) pelvic compartments through the vaginal introitus

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6
Q

what are the old and new systems used to grade pelvic organ prolapse?

A

old: balden walker
new: “POP-Q”

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7
Q

how is the “pop-Q” system scored?

A

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

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8
Q

UA culture shows sensitivity to nitrofurantoin, can you treat the pyelonephritis with this?

A

no, b/c nitrofurantoin does not penetrate to the kidneys. need ciprofloxacin or levofloxacin. also can do bactrim.

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9
Q

best drug for acute migraine treatment?

A

sumatriptan, but best when taken in prodrome.

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10
Q

pelvic organ prolapse in anterior (cystocele) or posterior chamber (like a rectocele) needs what kind of treatment?

A

colporrhaphy with plication of the anterior endopelvic fascia or rectovaginal fascia

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11
Q

treatment for apical (middle) compartment pelvic organ prolapse ?

A

Uterosacral ligament suspension or sacral colpopexy

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12
Q

acute mitral regurg from papillary muscle rupture after MI presents with what two symptoms?

A

pulmonary edema and a systolic murmur.

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13
Q

murmur of aortic insuficiency

A

high-pitched, blowing diastolic murmur heard best at the left sternal border.

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14
Q

postmyocardial infarction syndrome aka ?

A

dressler syndrome - post-MI pericarditis

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15
Q

treatment options for mallet finger: conservative vs surgical decisions?

A

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.

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16
Q

at what age should the majority of males have palpable testes? how do you find it?

A

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.

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17
Q

TPA absolute contraindications (5 general categories)

A
  1. head Sx, trauma, stroke or bleeding in past 3 mo
  2. known brain mass/aneurysm/AV malformation
  3. active internal bleed, bleeding condition
  4. uncontrolled HTN
  5. abnormal blood glucose,
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18
Q

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?

A

HX of CA

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19
Q

first and second line txt for Cdiff

A
  1. vancomycin 2. metronidazole
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20
Q

MC cause :sudden onset of target-shaped lesions on the extensor surfaces of the arms and palms of the hands. They are asymptomatic.

A

erythema multiforme: HSV
* can also be caused by mycoplasma
sulfa and PCN drugs

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21
Q

MOST important primary prevention for recurrence of skin cancer

A

sun safe behavior (over yearly physicals)

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22
Q

Txt of HIT?

A

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.

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23
Q

plt transfusion for HIT?

A

*A platelet transfusion should be avoided in most cases, unless acute bleeding is present.

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24
Q

steps to Dx asthma in acute onset of symptoms in primary care office

A
  1. oxygen saturation check
  2. If low, a nebulizer would be the next most likely step
  3. Definitive diagnosis requires spirometry once the patient is known to be stable
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25
Q

biggest risk factors for urinary stress incontinence?

A
  1. age

2. vaginal childbirth

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26
Q

what imaging is used for screening for AAA?

A

ultrasound

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27
Q

staging of AC joint injuries (type 1-3 and the corresponding recommendations for time to return to play). which types need ortho referral?

A

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

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28
Q

initial treatment for anterior epistaxis

A
  1. direct pressure- tamponade

2. chemical cauterize/thrombogenic foam/ balloon

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29
Q

suspected third interspace Morton’s neuroma, which treatment modality in primary care is associated with the best outcome?

A

steroid injection (+/- cause permanent numbness) - only 30% success rate

  • Sx if failed.
  • orthotic pads have little proven benefit
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30
Q

screening guidelines for gestational DM

A
  1. 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
  2. 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
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31
Q

txt options for gestational DM, risk of 2nd line?

A

best - insulin

2. glyburide (risk of eclampsia)

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32
Q

sugar goals fasting and post prandial for Gestational DM

A

goal fasting <95, post prandial <120

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33
Q

labor induction for gestational DM: uncontrolled DM/macrosomia vs controlled/no macrosomia

A

uncontrolled: 38 wks
controlled: 40wks

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34
Q

Dx and treatment of mild diverticulitis symptoms ?

A

no labs or CT needed. clear liquids +/- abx (cipro or bactrim + metronidazole)

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35
Q

pain with mortons neuroma

A

lancinating (Stabbing) MC third metatarsal digit space, radiating to toes on either side.

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36
Q

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?

A

ewing sarcoma
(osteoid osteoma is not associated with a mass, osteoid sarcoma is found at metaphysis, myosarcoma is found in large muscles)

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37
Q

vaccines reccomended for 65yo+?

A

pneumoccocal 23 and 13, up to date on Tdap and flu.

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38
Q

causative organism and treatment for erysipelas

A

strep pyogenes + PCN

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39
Q

Dx of lactose intolerance

A

hydrogen breath test (after trial of lactose free diet)

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40
Q

dermatitis herpetiformis is common in what disease?

A 
celiac dz (sprue) 
- itchy, papulovesicular all over body
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41
Q

Dx celiac dz

A

endomysial IgA Ab and transglutaminase Ab

definitive = small bowel biopsy

42
Q

ogilvie’s syndrome

A

colonic pseudoobstruction (acute dilation without mechanical obstruction). MC cecum and right hemicolon. MC after surgery, old, meds, etc

43
Q

3 options for txt for ogilvies syndrome

A

conservative (IV fluids/electrolytes), neostigmine, NG suction/enema decompression

44
Q

what is neostigmine and what is it used for?

A

parasympathomimetic that acts as acetylcholinesterase inhibitor (so increases Ach) - txt for myasthenia gravis, ogilvies syndrome, urinary retention

45
Q

best drugs to decrease mortality of HF, how do you choose which?

A
  1. ACE-Is
  2. ARB (if unable to tolerate ACE)
  3. BBs (carvedilol, metoprolol, bisoprolol) - used in addition to or if CI for ACEs/ARBs
46
Q

ADRs and CI for ACE-Is in HF?

A

ADR: cough, angioedema, hypotension w/ first dose, hyperK, renal insufficiency (esp

47
Q

at what GFR and/or serum Cr is dialysis indicated?

A

GFR <10 or Serum Cr >8

48
Q

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?

A

colposcopy with Bx - concern for vulvar intraepithelial neoplasm (VIN)

49
Q

what ultrasound finding is consistent with intussusception

A

target sign

50
Q

hypertension, headache, sweating, palpitations, anxiety with a sense of impending doom, and tremor. Dx = ?

A

pheocromocytoma

51
Q

txt of pheocromocytoma?

A

treat HTN w/ CCBs or alpha blockers

need BP control before tachycardia control with BBs

52
Q

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?

A

Nail must be removed and the nailbed repaired with an absorbable small gauge suture (6-0).
*unstable/ neurovascular compromise = ortho referral

53
Q

permission to perform a new prodcedure must be documented in what legal document?

A

Your credentialing/privileging agreement

54
Q

when is elective cesarean delivery indicated with placenta previa? why not induce labor?

A

between 36 and 37 weeks gestation if < 2cm from the os

induction of regular labor puts patient at risk of abruptio placenta and bleeding

55
Q

txt for rosacea?

A
  1. Abx- metronidazole or clindamycin

NOT steroids

56
Q

hyphema (blood in the anterior chamber) will result in what other eye abnormalities?

A

increased intraocular pressure and decreased visual acuity

57
Q

What is your best serology test to monitor treatment for infected skin wound?

A

CRP (rises with acuity of infectious/inflamm process and falls with treatment)
-CBC and blood cultures are good for initial eval and choosing treatment

58
Q

what lab values are essential to making the diagnosis of diabetic ketoacidosis? (blood glucose level, pH, bicarb, ketones?)

A

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

59
Q

______ refers to the ethical concept of treating everyone in a fair manner

A

justice

60
Q

In a patient with known idiopathic pulmonary fibrosis, which medication to improve the patient’s cough?

A

thalidomide (immunomodulator - works anti-inflamm)

NOT steroids

61
Q

what percent of lyme Dz patients have erythema migrans?

A

~75%

62
Q

ASD vs PSD murmur

A

ASD: early ejection systolic murmur with a wide split of the second heart sound.
VSD: pansystolic murmur.

63
Q

tetralogy of fallot murmur

A

harsh systolic murmur and a single second heart sound

64
Q

screening and test for excessive growth hormone

A

random serum IGF-1, if elevated –> oral glucose challenge test then measure serum growth hormone in 1 hr, acromegaly + is >1 ng/mL

65
Q

txt for chalazion ?

A

warm compress (NOT I+D unless refractory or recurrent)

66
Q

Dx for symptomatic lyme disease (<1month vs >1 month)

A

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

67
Q

pt w/ PNA from southwest US txt? (healthy vs high risk

A

inhalation for coccidiomycosis/valley fever spores (fungus)

  • healthy: supportive care
  • severe dz/immunocomp/pregnant: antifungal (fluconazole)
68
Q

txt for acute gout flares vs prevention/chronic gout

A

acute: NSAIDs (indomethacin), colchicine +/- steroids
chronic: allopurinol, febuxostat, probenecid

69
Q

what type of fluid is used to resuscitate hypovolemic shock?

A 
isotonic crystalloid(0.9% NS or lactated ringer) 
NOT hyper or hypotonic solution, or colloid
70
Q

what patient populations are at higher risk for flu complications (comorbidities, age, ejection fraction, pregnancy status)

A

DM, >65, EF <50% (indicated HF or cardiomyopathy), currently pregnant

71
Q

acute vomiting, RLQ pain, WBC > 15,000, temp >101, elevated ESR - which of these most indicate a pt has appendicitis?

A

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

72
Q

On review of the EKG, which finding will differentiate atrial fibrillation from atrial flutter?

A

irregular QRS response - Afib
regular - Aflutter
(both have narrow QRS, immeasurable PR and varying rate)

73
Q

which of the following test is most helpful in diagnosing an acute anterior cruciate rupture? (lachman or anterior drawer)

A

lachman

74
Q

possible water breaking you do a nitrazine test, what is the pH of amniotic fluid vs vaginal?

A

amniotic >7 , normal vaginal ~4

75
Q

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.

A

mitral stenosis

76
Q

murmur of mitral valve prolapse

A

mid-systolic click, followed by a late systolic murmur best identified at the apex.

77
Q

A positive predictive value is defined as which one of the following statements?

A

Percentage of people with a positive test who have disease

78
Q

The ability of a test to correctly identify patients with disease = ?

A

sensitivity

79
Q

Which of the following structures is most commonly adversely affected in hypertrophic cardiomyopathy (HOCUM)?

A

left ventricle (not septum)

80
Q

high resolution CT is used for what?

A

lung abnormalities (not abdominal - which is just CT abdomen w/ or w/out contrast)

81
Q

Typically, a normal intra-uterine pregnancy will have a hCG double over __ hrs, what does abnormally rapid rise indicate?

A

48-72 hours

abnormal (high) rise may indicate ectopic

82
Q

The presence of which positive serologic markers would be found in a patient with a resolved acute HBV infection?

A

Anti-HBc IgG and Anti-HBs

83
Q

_______ appears during acute hepatitis B but persists indefinitely

A

IgG anti-HBc

84
Q

________ appears after clearance of HBsAg and after successful vaccination against hepatitis B

A

anti-HBs

85
Q

what symptoms can help differentiate meineire’s from labrynthitis

A

meneires: N/V

86
Q

To distinguish folate deficiency from vitamin B deficiency, which lab(s) should be ordered?

A

Homocysteine and methylmalonic acid

folate deficiency anemia: homocysteine level is elevated vitamin B12 deficiencies: both are elevated

87
Q

solitary thyroid nodules, fine needle aspiration biopsy is indicated for nodules larger than____ diameter with a suspicious appearance on ultrasound (i.e. solid, irregular)

A

0.5 cm

88
Q

level of eval and mgmt for patient problem: how is “comprehensive” and “detailed” different from problem focused and expanded problem focused

A

detailed: includes pertinent family and social Hx
comprehensive: includes complete FHx and SHx

89
Q

MC causative organism for otitis externa?

A

Pseudomonas aeruginosa

90
Q

how do symptoms of MS change with pregnancy?

A

Often, symptoms of MS improve during pregnancy and worsen after delivery.

91
Q

first line option for treatment of seborrheic keratosis

A

cryotherapy

92
Q

txt protocol for postpartum hemorrhage due to uterine atony

A
  1. rapid infusion of oxytocin
  2. bimanual massage
  3. activation of emergency protocols (i.e., OB alerts, fluid initiation, transfusion protocol, etc.)
  4. uterotonic administration (ergonovine maleate, carboprotost, and misoprostol)
  5. if failure…Balloon tamponade and uterine artery embolization
93
Q

S+S aortic aneurysm vs dissection

A

dissection = sudden/severe abdominal pain (but not always “tearing”), discordinant pulses, HTN

94
Q

symptoms of ASD- what are they like and what age do they come up?

A

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.

95
Q

delivery of baby + shoulder dystocia: what maneuvers are suggested and which are CI?

A

accepted: mcRoberts, delivery of posterior arm, zavanelli maneuver)
CI: fundal pressure

96
Q

best imaging Dx for pericardial effusion

A

echocardiogram

97
Q

Face presentation (head is hyperextended) in a term nulliparous woman where the mentum (fetal chin) is posterior - what is reccomended?

A

cesarean delivery

98
Q

Which of the following conditions is associated with posterior blepharitis?

A

Keratoconjunctivitis sicca (dry eye syndrome from meibomian gland dysfxn aka posterior belpharitis

99
Q

interstitial lung disease (such as silicosis) has increased risk of what other sequelae?

A

other autoimmune d/o and tuberculosis

100
Q

primary care mgmt of clavicle fracture? (sling, figure 8, urgent ortho consult? )

A

sling (figure 8 increases risk of necrosis )

urgent ortho consult reserved for open fracture and neurovascular compromise

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