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M3 Family Medicine AAFP > Practice question notes > Flashcards

Practice question notes Flashcards

1
Q

Last-ditch treatment for left BBB

A

Cardioversion if have maxed out medical therapy

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2
Q

Treatment of AAA

A

IV labetalol to get systemic BP <100-120

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3
Q

SVT treatment

A

IV adenosine

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4
Q

DOC HTN in AAs

A

CCB or diuretics over ACEi

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5
Q

What is Still’s murmur?

A

Benign childhood systolic murmur best heart at lower precordium; low, short tone

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6
Q

How is Lovenox eliminated?

A

Renal, do renal dosing

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7
Q

When do you give thrombolytics for heart attacks?

A

If LBBB - bc occluded LAD

Give for STEMI but not ST depression

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8
Q

What is ABI and what is a normal number

A

Systolic ankle/sys arm; 0.9-1.2

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9
Q

After 1st DVT?

A

Warfarin 3 months + LMWH

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10
Q

What is SMA syndrome?

A
  1. Vomiting, 2. Cardiac problems, 3. Leukocytosis
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11
Q

DOC a fib

A

BB for rhythm and rate

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12
Q

What do fibrates do

A

Lower TGs, inc. HDL

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13
Q

Niacin is contraindicated in __

A

diabetics

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14
Q

Treatment of WPW with SVT

A

Radiofrequency ablation, not digoxin

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15
Q

DOC for acute delirium/AMS

A

Haldol q 30 and more doses q necessary

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16
Q

High LDL found. Need to screen for:

A

Hypothyroid, DM, liver dz, CRF, meds

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17
Q

Treating arrythmias 2/2 cocaine, do NOT:

A

Don’t use BBs–>vasospasm

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18
Q

DOC intermittent claudication?

A

Cilostazol, a PDE5 inhibitor, C/I CHF

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19
Q

Subclinical hypothyroidism lab pattern TSH Te

A

TSH>10, normal T3. Assoc w high LDL

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20
Q

Lithium AEs

A

hypterthyroidism, renal impairment, congenital heart

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21
Q

Byetta/exenatide MOA

A

Increases gastric emptying time and C/I gastroparesis

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22
Q

DDx hot nodules thyroid

A

Grave’s, multinodular goiter, solitary hot nodule, TSH adenoma, molar pregnancy/choriocarcinoma

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23
Q

DDx cold nodules thyroid

A

Subacute thyroiditis, PP lymphocytic thyroiditis, radiation-induced, struma ovarii, follicular cancer

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24
Q

UC or Crohn’s which has an increased risk of colon cancer?

A

UC

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25
Q

Characteristics of Crohn’s (vs. UC)

A

No rectal involvement, transmural, segmental, fistulas

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26
Q

S/S radiation proctitis

A

Pain with defecation, diarrhea, rectal bleeding

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27
Q

Tx of traveler’s diarrhea

A

Cipro 3 days

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28
Q

MSM need this preventative service

A

HepA vaccine

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29
Q

Best test for hemochromatosis

A

Serum transferrin saturation (not Bx!)

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30
Q

Bilirubin over __ is always pathologic in neonates

A

17

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31
Q

Finding on peritoneocentesis dx of acute bacterial peritonitis

A

PMN>300/mL

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32
Q

Gilbert’s increased direct or indirect bili?

A

Indirect

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33
Q

IBS symptoms worsen:

A

At night

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34
Q

DOC torsades

A

Magnesium

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35
Q

Erythema toxicum neonatorum rash appearance

A

Flea bitten

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36
Q

DOC preventing spread of pertussis

A

Azithromycin

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37
Q

Tarsal coalition?

A

Bone fusion in adolescents. Often bilateral, ankle pain with dec ROM and pain with inversion

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38
Q

Os trigonum?

A

Non-ossification of cartilage; unilateral and palpable with heel tenderness

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39
Q

Sever’s apophysitis?

A

Heel pain from calcaneal inflammation

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40
Q

Navicular fractures

A

Tender over dorsomedial navicular

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41
Q

Bupropion weight gain?

A

NO

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42
Q

Delayed bone age as well as growth velocity suggest:

A

GH deficiency

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43
Q

What is xerosis?

A

Pathologic dryness, usually in the elderly, worst in winter

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44
Q

Test of choice hypogonadism in men

A

Total T

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45
Q

Treatment of hypercalcemia of pregnancy?

A

pamidronate

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46
Q

Valsalva maneuver and murmurs mechanism

A

Decreases venous return and CO

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47
Q

SCFE presentation

A

Overweight boys with limited internal rotation

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48
Q

Pts with immediate family member with colon cancer screening recommendations

A

Start at 40, q 5 years

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49
Q

These drugs act at the AV node and may worsen WPW by causing v fib

A

Adenosine, digoxin, and CCBs

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50
Q

DOC WPW

A

procainamide or amiodarone

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51
Q

SSRI DOC pregnancy

A

Prozac (fluoxetine)

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52
Q

Tx of severe BPP resistant osteoporosis?

A

Teriparatide (Teri is so strong) for up to 2 years

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53
Q

ASA recommendations

A

Men 45-79 to reduce MI risk

Women 55-79 to reduce stroke risk

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54
Q

Erythema multiforme is the rash of:

A

HSV

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55
Q

ASCUS–>

A

3 options: 1) repeat at 6 and 12 mo 2) test for HPV 3) colposcopy

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56
Q

Omeprazole decreases __ absorption

A

B12

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57
Q

Treatment of atrial flutter with acute HF

A

Cardioversion

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58
Q

Treatment of atrial flutter if pt is stable

A

Digoxin or verapamil

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59
Q

Patellofemoral pain syndrome

A

Active teenagers with anterior knee pain that worsens with running -> get PT

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60
Q

TZDs mechanism

A

Act on PPARg to increase insulin sensitivity

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61
Q

Vacuum or forceps?

A

Vacuum worse bc more dystocia, cephalohematoma, retinal hemorrhage

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62
Q

Trazodone side effects

A

Sedation, orthostatic hypotension

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63
Q

This antidepressant can worsen insomnia

A

bupropion

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64
Q

Mirtazepine is great for:

A

appetite stimulation and weight gain

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65
Q

ACD iron study pattern

A

Low TIBC, low serum iron, high ferritin

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66
Q

Preventing recurrent calcium stones

A

Low sodium diet, increase fluids, take K citrate at mealtime to increase urinary pH, also HCTZ!

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67
Q

Metabolic acidosis plus acute renal failure suggests:

A

Methanol poisoning; check gap, look for hypocalcemia, check for fluorescent pee

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68
Q

Treatment of methanol poisoning

A

fomepizole

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69
Q

Is glipizide safe for CKD?

A

Yes

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70
Q

Therapies for essential tremor

A

Propanolol, primodone

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71
Q

Who should be screened for diabetes?

A

BMI>25, Inactive, HTN, HDL250, A1C>5.7, Hx of GDM or PCOS

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72
Q

Spinal stenosis pain is relived by:

A

Sitting

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73
Q

Herniated disc pain is made worse by:

A

Sitting

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74
Q

Pseudogout joint findings

A

Short, blunt, rhomboid and cuboid crystals with lots of PMNs

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75
Q

Cat bite what do you do?

A

Prophylax for pasturella

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76
Q

Methadone worrisome cardiac effect

A

torsades

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77
Q

A fib low risk DOC anticoag

A

ASA 325

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78
Q

A fib high risk DOC anticoag

A

Warfarin

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79
Q

Cat scratch DOC

A

Azithromycin

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80
Q

Nortryptilline and duloxetine AEs

A

Worsen arrhythmias, worsen urinary retention

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81
Q

Celexocib AE

A

reflux

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82
Q

Which NSAID is on Beers list?

A

Indomethacin

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83
Q

Pain after cholecystectomy plus jaundice?

A

Retained common duct stone

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84
Q

Recommendations for gastric bypass

A

BMI>40 or 35-40 with comorbidity with dietician and mental health eval first

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85
Q

First test in patients with abnormal renal function plus hypertension

A

Duplex Doppler USG

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86
Q

Who should be screened for osteoporosis

A

Women over 65, men over 70, men and women 50-69 with risk factors

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87
Q

DOC ascites?

A

Spironolactone over loops

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88
Q

V tach acute treatment

A

amiodarone

89
Q

Bronchiolitis in ED best drug first?

A

Albuterol

90
Q

Contraindications to zolendronate

A

Hypocalcemia, creatinine less than 35

91
Q

ESRD associated with hypo or hyper pth?

A

hypoparathyroid

92
Q

Common EKG finding in anorexia nervosa?

A

Sinus bradycardia

93
Q

GC treatment?

A

Ceftriaxone 250 IM

94
Q

Chlamydia tx?

A

Azithromycin

95
Q

Zostavax is contraindicated in:

A

immunocompromised

96
Q

Sevelamer MOA

A

Blocks intestinal absorption of phosphate, lowering PTH

97
Q

Tx of acute otitis externa?

A

Cipro + dex

98
Q

Which type of renal stone needs acidification of the urine?

A

CA phosphate

99
Q

Calcaneal aphophysitis presents?

A

Heel pain in kids with tight Achilles, pain with dorsiflexion and activity

100
Q

Tx of SCFE?

A

Surgery; more common in blacks that are fat

101
Q

Length of thromboprhophylaxis for THA?

A

35 days

102
Q

Phenytoin long-term side effect?

A

osteoporosis, by increasing hepatic metabolism of vitamin D

103
Q

When to begin breastmilk supplementation and with what?

A

Vitamin D at 2 months

104
Q

Does polymyalgia rheumatica have increased CPK?

A

Nope

105
Q

In those on long-term prednisone, they also need to take:

A

BPP and vit D

106
Q

What are some drug options for incomplete response to an antidepressant?

A

T3, lithium, or atypical antipsychotic

107
Q

Pertussis phases

A

Prodrome 1-2 weeks similar to URI, then paroxysmal coughing fits

108
Q

Baby has rash on perineum that’s not diaper? What is the organism

A

GAS

109
Q

What is an appropriate monotherapy for exercise induced asthma?

A

Pre-activity beta agonist

110
Q

Posterior tibial tendonopathy presentation

A

women over 40 with no trauma, but pain with plantarflexion an worse with foot inversion

111
Q

How are sulfonamides teratogenic?

A

Kernicterus in 3rd trimester

112
Q

Rare side effect of dextromethorphan?

A

Serotonin syndrome

113
Q

How do you interpret an AM cortisol test? High low etc

A

> 13 excludes adrenal insufficiency; if <13, need to do ACTH stimulation test

114
Q

All patients with HHT (OWR) need to be screened for:

A

Pulmonary venous malformations by contrast echo

115
Q

Best way to image septic arthritis of hip?

A

USG

116
Q

Treatment of Paget’s bone?

A

BPP

117
Q

Presentation of acute closed glaucoma

A

Severe pain, blurry vision, halos, increased extra-ocular pressure, red conjnctiva, dilated pupils, hazy cornea

118
Q

What is Gottron’s papules?

A

Flat violaceous papules on knuckles nearly pathognomonic for dermatomyositis

119
Q

Which arrhythmia is adenosine used for?

A

SVT

120
Q

How to check vit D levels?

A

25-OH, not D3

121
Q

What is rifamixin used for?

A

Unabsorbed antibx that reduces ris kof traveler’s diarrhea

122
Q

Who should avoid zanamavir?

A

COPD

123
Q

Clonidine is C/I in:

A

Depression

124
Q

Working up an incidental adrenal mass (not imaging)

A

O/N dex test; if cortisol >5, indicates adrenal hyperfunctioning

125
Q

Glucose goal for gDM

A

Fasting 95 or less

126
Q

Do not use ziprasidone in combination with these drugs

A

Clarithromycin, TCAs, or antiarrhythmics bc of qt prolongation

127
Q

Sjogren’s antibodies to check

A

anti SSA and SSB

128
Q

What is empiric therapy for suspected bacterial endocarditis?

A

Vanc + gent

129
Q

Aricept increases risk for:

A

Cataracts

130
Q

You find large parotid glands in someone. You should check to see if they have :

A

Diabetes

131
Q

Drugs to reverse acute dystonia?

A

Diphenhydramine or benztropine

132
Q

What is linagliptin?

A

DPP4 inhibitor

133
Q

What is exenatide?

A

GLP analog

134
Q

What is saxagliptin?

A

DPP4 inhibitor

135
Q

What is sitagliptin?

A

DPP4 inhibitor

136
Q

What is liraglutide?

A

GLP analog

137
Q

What is glyburide?

A

Sulfonylurea

138
Q

What is glimepizide?

A

Sulfonylurea

139
Q

What is glipizide?

A

Sulfonylurea

140
Q

What is pioglitazone

A

TZD

141
Q

ST elevation in leads V1-V6, which artery is clogged?

A

LAD

142
Q

ST elevation in leads II, III, aVF, which artery is clogged?

A

RAD

143
Q

ST elevation in leads I, aVF, which artery?

A

Circumflex

144
Q

Treatment for bullous impetigo?

A

Bactrim

145
Q

Telogen effluxivum timeline

A

Hair loss 3 months after a stressful event that lasts 6 months after removal of the stressor

146
Q

Iron anemia lab pattern TIBC ferritin reitulocytes

A

high TIBC, low ferritin, reticulocytosis 1 week after supp

147
Q

ALT >3x UNL is specific for

A

gallstone pancreatitis

148
Q

What is Behcet’s disease?

A

Asians with eye problems, cutaneous sensitivity, esp needle pricks

149
Q

Most sensitive 1st trimester option to screen for Down’s?

A

Chorionic villus sampling

150
Q

How do you monitor Lovenox?

A

Anti-Xa levels

151
Q

How do you monitor LMWH?

A

PTT

152
Q

Long-term use of H2 blockers or PPIs decreases __ absorption

A

Ca carb, so use Ca citrate

153
Q

Where are the common fibromyalgia spots?

A

Medial scapula, back of neck, medial knee

154
Q

Best SSRI for adolescents?

A

Fluoxetine

155
Q

Tx of fungal toenail infection

A

Oral terbinafine 12 weeks

156
Q

If PSA is >40, then:

A

Start 5 alpha reductase inhibitors

157
Q

Otosclerosis presentation

A

Women in 20s-40s with progressive conductive hearling loss

158
Q

Ottawa rules for X-raying ankles

A

Image if unable to take 4 steps, local navicular tenderness, local 5th MT tenderness, posterior or tip of malleolus is tender (Malleolus, Navicular, 4 steps, 5th metatarsal)

159
Q

What is trifascicular block?

A

RBB + L anterior hemiblock inc risk of arrhythmia and bradycardia, so do heart monitoring

160
Q

A 2nd PPD is + after a - one a few days before, what does that mean?

A

Long-standing latent infection

161
Q

What is Hawkin’s impingement test?

A

Pain w int rot while 90 flex and 90 elbow - indicates rotator cuff

162
Q

What is granuloma annulare?

A

Self-limited , not congaeious, treat with steroids. Red bumps on skin arranged in rings, usually on hands or feet

163
Q

DI urine findings

A

Uosm < 300

164
Q

Pressors used for septic shock

A

NE and DA

165
Q

Tx of orthostatic HTN

A

Fludrocortisone, midodrine, physostigmine

166
Q

What is a J sign?

A

Patella moves medial to lateral when extended

167
Q

BZDs for alcohol withdrawal?

A

Long-acting like chlordiazepoxide

168
Q

SIADH UA

A

FeNa>1, Uosm high

169
Q

Differences between Waldenstrom’s, MM, and MGUS?

A

Waldenstrom’s has kappa Igm with lymphocytes, MM has plasma cells instead, MGUS has no BJ proteins like the others

170
Q

Varicocle - which side is worrisome

A

R. Usually they are on L and unilateral. On R should be susp for abdominal or intraperitoneal mass

171
Q

Which SSRIs have the highest withdrawal symptoms?

A

Venlafaxine (Effexor)

172
Q

Preventing contrast nephropathy before CT

A

Give N-acetylcysteine

173
Q

Tx of SIADH in a stable patient

A

Water restriction

174
Q

Marfan’s suspected, need to do:

A

Echo

175
Q

What is DRESS syndrome?

A

Drug reaction with eosinophilia and systemic symptoms; erythroderma plus fever, LAD, LFTs

176
Q

Gonococcal conjunctivitis pres and tx

A

2-5 days life, tx ceftriaxone IM

177
Q

Tx of dog and cat bites

A

5-7 days augmentin

178
Q

Bacteria commonly associated with closed fist injuries?

A

Eikenella

179
Q

What is amaurosis fugax?

A

Blockage of opthalmic artery leading to transient eye problems, assoc w strokes

180
Q

What is the ABCD scoring system for people who have a TIA?

A

Age, BP, Clinical features, Duration/diabetes - identifies those at high risk of stroke within 7 days of TIA: BP >140/>90 1, Clinical 1, duration > 60 min 2 pt, less than 1 hr 1 point, diabetes 1 point

181
Q

Aphasia during stroke indicates this artery is occluded or bleeding

A

MCA

182
Q

Stroke work-up, acute

A 
Head CT w/o contrast
EKG
MRI if symptoms have already resolved, w/in 24h
Non-hemorrhagic: ASA w/in 48h
tPA if w/in 3 hours
Watch for post-stroke brain edema
183
Q

How long should PEP be given for HIV

A

4 weeks, with TMP-SMX, ideally within 2 hours

184
Q

What are the stages of AIDS?

A

1 CD4 >500, 2 CD4 200-499, 3 (AIDS) CD4<200 plus AIDS-defining condition, 4 Unknown labs with AIDS-defining

185
Q

Clinic follow-up for someone with AIDS

A

Measure CD4 count q 3-6 mo, with CBC, CMP, UA at baseline and periodically to monitor for complications of HIV and its drugs; serology for toxo and CMV, screen for other STDs, do PPD too; women need regular Pap smears with HPV dna

186
Q

When do you begin PCP pneumonia prophylaxis in AIDS?

A

CD4<200 with TMP-SMX

187
Q

When do you begin MAC prophylaxis?

A

CD4<50 with azithromycin or clarithromycin

188
Q

What are some risk factors for hepatitis A?

A

International travel, contaminated foods (raw oysters esp)

189
Q

Which form of bilirubin is excreted in the urine?

A

Conjugated, while unconjugated is albumin-bound

190
Q

Mild unconjugated hyperbili off and on throughout a patient’s life w/o symptoms…

A

Gilbert’s

191
Q

How is hep A transmitted?

A

Fecal-oral

192
Q

What is the average incubation for hep A

A

25-50 days

193
Q

How long does the hep A icteric phase usually last?

A

6-8 weeks

194
Q

Who should get the hepatitis A vaccine? Besides just MSM

A

Children age 1, children 2-18 in high risk counties, traveler’s to endemic areas, persons with chronic liver disease or clotting disorders, IV drug users, HIV+, high risk exposure workers, and anyone who desires immunity

195
Q

What is the incubation time for hep B?

A

6 weeks to 6 mo., but only 50% are ever symptomatic

196
Q

Risk of developing chronic hepatitis from the B virus is related to:

A

Age at infection; 90% of infants, but 5% of adults

197
Q

This is responsible for 80% of HCC worldwide

A

hepatitis B

198
Q

A patient is found to be anti-HBcAg IgM positive, with all other antibodies negative. What does that mean?

A

Window period

199
Q

What percentage of those infected with hep C will develop chronic infection?

A

60-80%

200
Q

What is the leading cause for liver transplant in the US?

A

Hep C

201
Q

LFTs…viral hepatitis usually causes this one to be very high

A

ALT

202
Q

What is the preferred non-invasive office test for H pylori now?

A

Stool antigen because of superior PPV, but must be off PPIs for at least 2 weeks

203
Q

Drawback of H pylori serology

A

Cannot distinguish active vs treated infection

204
Q

Roseola course

A

High fever and mild URI for up to 5 days, then exanthem of maculopapular eruption on face for 1-2 days

205
Q

A new breast mass in women over 35 should undergo:

A

Triple assessment, with clinical exam, mammography, and either core biopsy or surgical excision

206
Q

For women under 35, suspected lesions of fibroadenoma or fibrocystic change may be assed with:

A

USG, or rarely mammogram w/ FNA

207
Q

DOC for breast pain

A

Danazol

208
Q

Drugs that cause galactorrhea

A

SSRIs, TCAs, atenolol, verpamil, antipsychotics, H2 blockers, opiates, estrogens

209
Q

What are Bouchard’s and Heberden’s nodes?

A

Bouchard: DIP
Heberden: PIP
Subluxed OA

210
Q

Pseudogout

A

Pseudogout most often affects the elderly, and usually affects the knee, wrist, and ankle. Joint contains rhomboid-shaped, weakly POSITIVE birefringent calcium pyrophosphate

211
Q

What are you worried about with premature closure of the fontanelles?

A

Craniosynostosis, if suspected get skull radiograph initially and if seen do CT

212
Q

Tramadol should be used with caution in those with:

A

seizures esp older ppl

213
Q

What are the approved treatments for men with osteoporosis?

A

Alendronate and PTH hormone

214
Q

What is the treatment to reverse nerve gas (sarin)?

A

Atropine (anti-cholinergic)

215
Q

What is the most effective drug for alcohol abuse?

A

Naltrexone

216
Q

A post-traumatic air-fluid level in the sphenoid sinus is associated with:

A

A basal skull fracture

217
Q

To test for median nerve inact after cut to hand ask them to:

A

Oppose thumb to pinky

218
Q

What is autonomic hyperreflexia?

A

Sudden-onset sympathetic symptoms in those with spinal lesions above T6; fairly common; main concern is hypertension

219
Q

This pain medication should be avoided in the elderly because of seizure risk

A

Meperidine (metabolite causes seizures sometimes)

M3 Family Medicine AAFP (1 decks)

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