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AFP boards > Q Bank 2 > Flashcards

Q Bank 2 Flashcards

1
Q

Tx for upper airway cough syndrome

A

Decongestant
po or IN antihistamine
IN corticosteroid
Saline rinses
PE fingins - swollen turbinates and posterior pharyngeal cobblestoneing
Refer to allergy if no improvement after 2 months

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2
Q

If you suspect a bicep tendon tear what do you do next?

A

Get an MRI

PT isn’t going to be helpful

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3
Q

At what HA1C level do you need to add a second agent?

A

> 9%

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4
Q

Time to peak effect of po opioids?

A

1 hour

IV reaches peak in 10 minutes

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5
Q

What is the only tx that reduces mortality in pHTN related to COPD?

A

Supplemental O2

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6
Q

What anti HTN meds lessen severity of OSA?

A

Diuretics, especially spironolactone d/t aldosterone effect

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7
Q

What test is most specific for fibromuscular dysplasia?

A

MRA of the renal arteries

OR CT Angio

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8
Q

Greatest risk factor for developing OA?

A

Obesity

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9
Q

Tx for exercise induces asthma?

A

SABA 15 min before their run

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10
Q

Pt has pain anterior to L ear extending to mandible. VSS. L parotid is diffusely enlarged, tender and purulent material is coming from the L parotid duct orifice. tx?

A

Augmentin
Dx - acute parotitis
caused by dehydration
can also try lemon drops and parotid gland massage

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11
Q

What is an absolute contraindication for testosterone therapy

A 
PolycytemaHCT > 54%
Breast cancer
prostate cancer
PSA > 4
ABN rectal exam w/ nodule
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12
Q

Most effective medication to help maintain alcohol abstinence?

A

Acamprosate

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13
Q

Common cardiac anomaly in Marfan’s?

A

Aortic insufficiency

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14
Q

40 + Pt with 30 pyr smoking history has “quarter size” hemoptysis. Now what?

A

CT chest

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15
Q

Football player has pain limiting practice at proximal 5th metatarsal, Xray negative. Now what?

A

Order MRI of foot

If + get a hard shoe x 3 weeks with progressive activity and NSAIDs as tolerated

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16
Q

If you want to start an atypical antipsychotic on a dementia pt, what do you tell family regarding side effects?

A

Risk of mortality is increased

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17
Q

Which type of T2DM meds are likely to cause weight gain?

A

Sulfonylures (glimepiride)

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18
Q

Teen M Tanner 3 has a lump on L chest under areola. No nipple discharge or adenopathy. Next?

A 
Follow up in 6-12 months
Adolescent physiologic gynecomastia
Normal in up to half of M teens
Resolves in 6-24 months
Be concerns if: present >2 years, hard/immobile/nontender, >5cm, nipple discharge, testicular mass, weight loss
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19
Q

Man has itchy rash around nasolabials and mustache. Tx and Dx?

A

Seborrheic dermatitis
Erythematous patches with white/yellow greasy scales
Tx - TOP anti fungal

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20
Q

Next step for peripartum depression?

A

Refer for therapy

Peripartum blues lasts <10 days

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21
Q

1st line Tx for RA?

A

Methotrexate

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22
Q

You want to start a statin on a pt planning to undergo planned TKR in 6 months. How do you counsel?

A

Start now to decrease risk of CV did and preoperative mortality

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23
Q

Male, just quit smoking has microscopic hematuria on UA>. What does he need next?

A

Cystoscopy

Indicated if pt > 35

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24
Q

1st line Tx for T2DM?

A

Metformin

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25
Q

Pt has allergies 5-7 days/wk x 6 months despite Allegra. Next tx?

A 
IN budesonide (Rhinocort)
Pt has persistent allergic rhinitis (syx >4 days x > 4weeks)
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26
Q

Tx for a venous stasis ulcer?

A

Compression Therapy

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27
Q

Cut off GFR for Gadolinium in MRI?

A

<30

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28
Q

Most important factors to prevent Post party hemorrhage?

A

Active management of 3rd stage of labor

Giving oxytocin after delivery of anterior shoulder

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29
Q

During a code you see Vtach. What do you do?

A

Defibrillation

If unsuccessful give episodes and def again

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30
Q

In pts with COPD which INH have been shown to reduce exacerbation and exacerbation related hospitalizations?

A

Tiotropium (Spiriva)

Beter than LABA (Salmetrerol)

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31
Q

Otherwise healthy patient has mildly elevated LFTS with negative viral hep panel. LFTs elevated on 2 occasions. Next?

A

US and ferritin

r/o hemochromatosis before working up FLD

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32
Q

Best way to determine if a pt is safe to take metformin?

A

eGFR

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33
Q

Initial Tx for Sarcoid

A

Prednisone

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34
Q

Pt has depression syx present x several years but is worse around menses, but present all throughout the month. Dx?

A

Dysthymia

In premenstrual dysmorphic disorder syx would only be present around menses

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35
Q

M pt has rash on neck where beard is x 1 year. Exam - curly facial hair, slightly tender, red hyperpigmented papules. Dx and Tx

A

pseudofolliculitis barbae - more common in folks with curly hair. Hairs are cute an an angle and curl in on themselves creating a foreign body rxn
Tx - electric clippers or to stop shaving

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36
Q

Teenager with athletes triad (BMI 16) and amenorrhea, what studies do you need?

A

BhCG
FSH/LH
TSH
DEXA

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37
Q

DVT Tx in pregnancy?

A

SQ Lovenox

Warfarin and DOACs have not been studied in pregnancy

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38
Q

PCOS patient has hyperpigmented patches along mandible. Dx and what med is causing it?

A

Melasma

Associated with pregnancy, OCPs, anticonvulsants

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39
Q

Medications that improve mortality in HFrEF

A

ACEI
Bblck
ARBs
Aldosterone antagonists (Spironolactone)

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40
Q

Pt with active cancer has a new PE. What are they d/c’d on?

A

Lovenox

DOACs haven’t been studied in malignancy

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41
Q

Pt on Warfarin for afib is planning to undergo surgery. How do you manage warfarin?

A

Stop 5 days prior to surgery and restart 12-24h post operatively unless there is a complication

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42
Q

Pt has dysphagia to solids but not liquids. Next?

A

EGD

C/f structural lesion

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43
Q

Pt with CAP was d/c’d on supplemental O2. Home health aid trialed pt off O2 x 1 hour and Sat >90%. What do you do?

A

d/c supplemental O2
No real benefit once they are over 88%
keeping pt on O2 too long increases risk of falls, fires, mucosal irritation

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44
Q

PCOS treatment associated with great live birth and ovulation rates

A

Letrozole (Femara)

Beter than clomiphene

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45
Q

Pt has sudden onset of multiple well circumscribed brown, oval, rough papule with “stuck on appearance” weight loss, pallor. What is on ddx and what to do next?

A

Sudden appearance of multiple seborrheic keratoses concerning for underlying malignancy - most common is adenocarcinoma of the stomach
Needs EGD and c-scope
NOT skin bx

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46
Q

Tx for Rocky Mountain spotted fever

A

Doxycycline

Start ASAP to decrease mortality

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47
Q

What T2DM medications are you hesitant with in a pt with hx of pancreatitis?

A

DPP-4 Inhibitor (Sitagliptin (Januvia))

GLP-1 agonist (Liraglutide (Victoza))

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48
Q

What co-morbidity can falsely lower the HA1C in a T2DM pt

A

Hemolytic anemia

Not Asplenia, IDA, CKD, Bit B12 deficiency - increases HA1C d/t increased longevity of RBC

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49
Q

Syx of Lithium toxicity

A

Often triggered by an inciting event (volume depletion, change in renal fxn)
Syx - GI upset, arrhythmia, CNS changes (tremor, confusion, agitation)
Usually a chronic toxicity seen in elderly patients d/t low muscle mass and decreased GFR. Usually follows an illness

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50
Q

How many days of abx should a routine CAP receive?

A

5 days. No benefit of longer courses

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51
Q

Asthmatic poorly controlled on Albuterol. Next step?

A

Fluticasone/salmeterol (Advair)

ICS/LABA

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52
Q

2 most common etiologies of neonatal sepsis?

A

1st - Group B Strep
2nd - E coli
Listeria is pretty uncommon now. Staph aureus and Group A strep are possible, but less likely. Strep pneumonia does not cause neonatal sepsis

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53
Q

Pt is bothered b tinnitus. What else should you check for?

A

Sensorineural hearing loss

Most tinnitus is idiopathic, but it is also associated with hearing loss

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54
Q

Penile lesions x 6 months, reddish-blue papule on the scrotom with a few similar lesions on the shaft. Dx?

A

Angiokeratomas
No tx needed unless bleeding
If present on shaft, suprapubic region or sacrum could be associated w/ Fabry dz and should be referred

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55
Q

Penile lesion - small skin colored dome shaped populates in circular pattern around coronal sulcus

A

Pearly penile papules

Benigns

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56
Q

Penile lesion - discrete pinhead-sized hypopigmented papule, asymptomatic. Can be scattered over penis and abdomen/legs

A

Lichen nitidus

Benign

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57
Q

Penile lesion - hypopigmented lesion with the texture of cellophane, usually on glans or prepuce. Atrophy, erosions, bull are common.

A

Lichen sclerosus - can be associated with SCC

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58
Q

Uncircumscrised M over 60 y/o - penile lesion beefy red, raised, irregular plaques on the glans, meatus, frenulum, coronal sulcus, prepuce. Can be ulcerated or crusted. Pain, itch common

A

squamous cell Carcinoma in situ (need Bx)

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59
Q

Pt hs 10 yr hx of HA QD. b/l with pressure/tightening quality w/o phono or photophobia. tend to worsen as day progresses. dx and tx?

A

chronic tension type HA

Amitriptyline can reduce HA duration and severity

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60
Q

1st line tx of diabetic neuropathy

A

Pregabalin (Lyrica) or gabapentin

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61
Q

F pt with hair loss, has a smooth circular area of complete hair loss on scalp w/o skin changes. Tx?

A

Intralesional corticosteroids
Dx - alopecia areata - chronic relapsing immune mediated inflammatory disorder affecting hair follicles causing patchy hair loss
IF over 50% of scalp is involved can use TOP immunotherapy
TOP steroid is only used in kids or adults that can’t handle the injection

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62
Q

What’s the formula for fluids in sepsis?

A

30mL/kg in first 3 hours in 500mL boluses

Lactate >3.6 suggests severe dz even if BP is ok

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63
Q

When do women need breast MRIs

A

Women at very high risk of breast cancer

ie - known genetic mutations, history of breast irradiation, high risk FHx, chest radiation (ie for Hodgkin’s dz)

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64
Q

Bball player has pain and flexion deformity in DIP joint. What wouldn’t make you want more of a work up before splinting?

A

Pt is unable to passively fully extend the joint
Hallmark of mallet finger is that pt can’t actively extending DIP joint.
However, inability to passively extend the DIP joint suggests trapped soft tissue or bone that may require surgery
IF > 30% avulsion needs ortho referral
Tx - splint with strict avoidance of keeping DIP joint in flexion even if delayed presentation. Can do activities even with splint in place

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65
Q

Pt under 65 needing both PCV 13 and PPSV23?

A

Chronic renal failure

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66
Q

Pt Under 65 needing just PPSV23

A 
Chronic lung dz
T2DM
heart disease
smoking
EtOH abuse
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67
Q

Sudden facial droop, unable to furrow brow on that side. Tx?

A

Valacyclovir and tapering dose of steroid
Dx - Bell’s palsy
Antiviral + steroid more effective than steroid alone and if started within 72h of onset

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68
Q

Test to dx Cushing syndrome

A

24h urinary cortisol

NOT dexamethasone depression

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69
Q

Obese smoker with NL FEV/FVC ratio but Bicarb is 35. Dx?

A

Obesity-hypoventilation syndrome

Restrictive on spirometry

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70
Q

What is a complication of having an over treated hypothyroid with TSH <0.1

A

Increased risk of hip and vertebral fx

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71
Q

young pt with weight loss, oral thrush, lymphadenopathy, ulcerative esophagitis, c/f?

A

HIV

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72
Q

Dx and tx of honey crusted lesions on a kiddo?

A

Impetigo

TOP mupirocin

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73
Q

31 wk GA preggo is given tocolytics and betamethasone and d/c’d 2 days later with stable cervical exam. Returns 2 weeks later with contractions and unchanged exam. Now what?

A

Expectant management. Goal of tocolytics prior to 34 weeks is to allow betamethasone time to work
No benefit in tocolytic for one more week

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74
Q

Trigger points in fibromyalgia?

A

Medial scapula borders, posterior neck, upper outer quadrants of the gluteal muscles, medial fat pads of knees

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75
Q

1st line CAP tx for output of young adult

A

Azithromycin

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76
Q

RF for intermittent claudication

A

T2DM
Smoking
HTN
dyslipidemia

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77
Q

A singer has had hoarseness x 10 days, she wants to sing again as soon as possible

A

No talking whispering, throat clearing for 48 hours

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78
Q

when would you get labs on a kiddo with acne

A

acne in mid childhood (>1 yr to 8 y/o)

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79
Q

Start ASA at what ACSVD cut off

A

10%

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80
Q

Hallmarks of baby friendly hospital

A 
Counsel on breast feeding, esp w/in 1 hour of birth
No other fluids or foods
Roomin in
BF on demand
No pacifiers
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81
Q

Tx for pituitary adenoma

A

<10 mm –> bromocriptine

> 10 mm –> surgery

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82
Q

Tx for acute bronchitis

A

Sudafed, honey, guaifenesin

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83
Q

which patients need abx before dental procedures?

A

prosthetic heart valves
Previous dx of endocarditis
unprepared cyanotic congenital heart disease (or repaired with residual shunt), heart transplant w/ regurgitation
Tx - Amoxicillin 2g once

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84
Q

type of therapy that works for OCD

A

CBT

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85
Q

At what age do you consider life expectancy when referring for screening c-scope

A

75

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86
Q

18 m/o WCC not meeting gross motor milestones. What would suggest MD?

A

Head lag when sitting up

Think syx d/t muscle weakness. Anything that suggests increased tone or hyperrreflexia is more c/w CP

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87
Q

Oligohydramnios is associated with what fetal anomalies?

A

Oliguria or anuria (renal genesis, obstruction from posterior urethral valves)

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88
Q

What abx combo would cover strep pyogenes and MRSA in a cellulitis?

A

Bactrim (MRSA) + keflex (Strep)

OR Clinda

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89
Q

At what age does a lazy eye become abnormal?

A

6 m/o - refer to ophtho

prior to 6 m it can be d/t imperfect coordination

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90
Q

most successful way to prevent travelers diarrhea?

A

Washing hands frequently or hand sanitizer

Avoiding street meat, tap water, ice, raw foods has not been shown to reduce risk

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91
Q

30 y/o G2P2 with amenorrhea, hot flashes, vaginal dryness x 1 year. Preg neg, NL TSH, prolactin. Elevated LH/FSH. Dx?

A

Primary Ovarian Insufficiency

Definition - menopause before age 40 d/t ovarian follicular depletion. Low estradiol, high FSH/LH

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92
Q

Most common cause of hypercalcemia?

A

hyperParathyroid

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93
Q

When do you think about doing NG feeds in a bronchiolitis?

A

RR >60, too hard to tolerate feeds

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94
Q

All pt handouts should be writing to what level?

A

5th grade

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95
Q

Pt is on chronic oxygen for knee OA. Refuses NSAID and PT. What do you do?

A

Taper oxycodone by 5-10% every 1-4 weeks

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96
Q

Teen football player has R shoulder pain d/t lots of throwing practice. Pain when raising hand above shoulder, +TTP proximal and lateral humerus. Dx and work up?

A

Little league shoulder (disruption at the growth plate of the humerus)
Get XRAY - look for widening, demineralization, or sclerosis at the growth plate.
If Nl Xray but suspicion still high get bone scan or MRI

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97
Q

sudden onset of pain and redness in eye, sluggish pupil reaction, decreased visual acuity

A

emergent referal to ophthalmology

c/f acute angle closure glaucoma

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98
Q

3 y/o turns toes in when he walks and has a clumsy gait. On exam feet point inward but patellae face forward. Dx and management?

A

Internal tibial torsion
No intervention, resolves spontaneously by age 5
May consider surgery if present at age 8 if symptomatic
no splints or shoe changes

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99
Q

62 y/o healthy female in rural NM has intractable n/v, hypotension after cleaning out a chicken coop and being exposed to rodents. blood Cx grow GNRs. Most likely pathogen?

A

Yersinia pestis

Kinda a dumb answer..

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100
Q

Human infection associated with contact of infected sheep, cattle, goats, dogs, cats

A

Coxiella burnetii
Gram neg
Q fevere

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101
Q

Human infection associated with contact of tissue rich in erythritol and fluids from goats and sheep

A

Brucella melitensis

Gram negative coccobacilli

102
Q

24 AA M cough x weeks, b/l facial n. palsy. NL CBC and UA. CXR w/ b/l LN enlargement. Dx?

A

Sarcoidosis
b/l FN palsy in <5% of cases
Can have hemoptysis d/t aspergillus infection/cavitation
Rare renal involvement

103
Q

Take what OTC supplement is associated with serious intracerebral bleeding if take with AC

A

Ginko biloba

104
Q

Which NSAID is safest to use in pt w/ h/o MI?

A

Naproxen

105
Q

Where is a tracheostomy inserted?

A

Cricothyroid membrane
Directly ABOVE the cricoid cartilage
lies below the larynx

106
Q

problem with having a RBB + L anterior hemiblock on EKG?

A

Trifascicular block puts pt at risk of tachyarrhythmias and bradyarrhythmias
if symptomatic, Needs cardiac monitoring to decide if pacemaker is needed

107
Q

Why do we do a 2 step PPD?

A

If second step is positive demonstrates that pt has long standing latent TB

108
Q

shoulder exam: forward flex am to 90 with elbow bent at 90. Internally rotate shoulder. Test name?

A

Hawkins’ impingement

suggest subacromial impingement

109
Q

4 w/o with cough, poor feeding, conjunctivitis, CXR with interstitial infiltrates. WBC with eosinophilia. Dx?

A

Chlamydia trachomatis

presents at 3-16 wk of age and can be sick for weeks.

110
Q

when and how to treat triglycerides

A

If >1000 would start fenofibrate in addition to lifestyle modification to lessen the risk of significant pancreatitis
can also start statin but statin won’t lower TG
Omega 3 can also lower TG and LDL but does not decrease mortality or CV events so not recommended
Niacin does increase HDL and LDL but studies have not demonstrated that CV outcomes are affected

111
Q

what medication can cause hyperthyroidism?

A

amiodarone

made up of 37% iodine

112
Q

Pt wants advice about DHEA?

A

It does not enhance performance or muscle strength

Precursor to testosterone and estrogen

113
Q

infection of the lateral nail fold

A

paronychia

Tx top abx +/- TOP steroid, po ab, warm compress. I&D if not responsive

114
Q

when leg is extended, patella deviates laterally. Dx?

A

patellofemoral syndrome

115
Q

cyp450 inducer

A

phenytoin

116
Q

preferred initial test in post menopausal VB?

A

TVUS

less invasive than EMB and if endometrial stripe <3-4 mm then carcinoma is r/o

117
Q

Pulmonary embolism is associated with which type of effusion?

A

exudative

118
Q

unvax preggo in 1st trimester found out hubs has acute hep b. what to do?

A

Give HBIG and Hep B vax now

119
Q

which vaccine preventable illness has had an increase in number of deaths in recent years?

A

Pertussis

adults lose immunity. Should get booster once between 19 and 65

120
Q

proximal muscle weakness with elevated CK

A

drug induced myopathy (usually d/t statin)

121
Q

proximal muscle weakness with elevated ESR

A

polymyalgia rheumatica

122
Q

best evidence to prevent fractures in postmenopausal women with osteoporosis?

A

Bisphosphonates

123
Q

pt has pelvic pain but during and exam you have her raise both legs off table which intensifies her pain. Dx?

A

Suggests MSK etiology
If pain was improved would call this Carnett’s sign which would decrease abdominal pain as the and muscles tighten because the taut muscle protects the viscera during the exam

124
Q

Pt admitted for CHF x2 weeks develops copious semi formed stool. Dx?

A

C diff

Long hospitalization even without abx use is a risk factor for c diff. Exposure to toxin

125
Q

pt has annular rash on dorsal of hands. Bx reveals granuloma annular. Now what

A

No tx. Self limited.

126
Q

when to screen for gDM?

A

24-28 wk

127
Q

Boxer fx of 5th metacarpal has < 40degree of angulation. Tx?

A

Ulnar gutter splint

>40 needs surgery

128
Q

Best US measurement to estimate gestational age

A

Crown rump length @ 10wks pregnancy

129
Q

Tx for HIV + with latent TB?

A

Isoniazid x 9 months

Rifampin is not recommended in HIV d/t resistance and drug interactions with HART therapy

130
Q

Pt has a cold sore and that 2 days later develops maculopapular rash in multiple areas that look like target lesions. Dx?

A

HSV

Rash = erythema multiforme and HSV is the most common etiologic agent

131
Q

What imaging study should you get for pts with hematuria?

A

CT urography (not RBUS)

132
Q

what can help reduce leg pain in PAD?

A

Statin

133
Q

Tx for neurogenic bladder (retention)

A

scheduled urination +/- Crede’s maneuver
+/- bethanechol
self-cath

134
Q

Tx for cocaine induced chest pain?

A

IV Ativan

135
Q

niacin can have side effect on which organ?

A

Liver

Hepatotoxitiy in elderly

136
Q

Well controlled t2dm on insulin is now having hypoglycemia despite no change in diet or insulin. Why?

A

Kidney disease

137
Q

2 y/o M isn’t walking, if c/f Duchenne MD what lab test would be helpful?

A

CK

138
Q

Most common cause of 24-48h food poisoning?

A

Staph

139
Q

How to confirm dx of Parkinson’s dz?

A

positive response to levodopa

140
Q

when does mid shaft clavicle fx need surgery?

A 
Older female (ie >50)
Comminution or displaced fx
clavicle shortening
141
Q

Tx for postpartum urinary retention

A

Foley or intermittent Cath

142
Q

common cause of wheeze in infants?

A

GERD

143
Q

Dosing of amoxicillin for AOM?

A

80-90mg/kg/day

144
Q

Surgeries with the highest risk of preoperative MI?

A

Aortic and peripheral vascular surgery

Emergent operations

145
Q

Tx for inpatient cellulitis w/o abscess

A

CTX, PCN, Cefazolin, clinda mono therapy

If purulent drainage or IVDU or MRSA + –> vanc

146
Q

Good exercises for low back/pelvic pain in 3rd trimester?

A

Core stability exercise (pilates, back extension, abd crunches)

147
Q

Presence of skin tags means a patient is at an increased risk of?

A

T2DM

148
Q

pt with polyuria, euvolemic on exam, 24h urine puts out >5L with low urine osmolality. Pt has a deficiency of?

A

arginine vasopressin

Dx DI

149
Q

problem with Sudafed in elderly?

A

Worsens urinary retention

150
Q

Pt with adrenal insufficiency on 5mg pred and 0.1mg fludrocortison has cellulitis. How do you manager her steroids?

A

Increase red to 15mg and keep fludrocortisone at current dose
Only increase fludrocortisone to stress dosing for surgery or major infection

151
Q

which elderly ppl have highest risk of dying in a heat wave

A

Home bound
bed bound
unable to do ADLs

152
Q

4 w/o m prominence on L scrotom

Oblong, nontender, non reducible, light transmitting mass closely adhered to testes. Dx and tx?

A

Hydrocele

Observe - resolves in week to months

153
Q

Pt wants to take a herbal supplement for anxiety. Rec?

A

Kava
works in short term (up to 6 months)
avoid hepatotoxins

154
Q

pain/tingling in medial aspect of ankle and plantar surface. worse with activity. Reflex hammer inferior to the medial malleolus causes parathesia. Dx?

A

Tarsal tunnel syndrome

155
Q

tx for tooth abscess

A

clinda

156
Q

pt w/ anosmia but no congestion. now what?

A

MRI brain - rare brain tumors can do this

157
Q

asyx pt has Tbili 1.8, indirect bili 1.3. all other labs nl. dx?

A

Gilbert syndrome

AD, elevated indirect hyperbole d/t impaired glucuronyl transferase activity

158
Q

which anemias have a normal rdw?

A

beta thalassemia

rdw measures variability

159
Q

tx for TMJ

A

Can do dental splints, but the majority of cases are self limiting

160
Q

What causes most cases of acute interstitial nephritis?

A

drug induced
usually 2 weeks after starting medication
associated with NSAIDs, abx (cephalosporins, PCN, sulfonamies, ahminoglycosides, rifampin), diuretics, allopurinol

161
Q

Tx for orthostatic hypotension

A

Fludrocortisone
Midodrine
Physostigmine

162
Q

What decreases mortality in CHF?

A

ACEI
B block
NOT CCB - decrease cardiac contractility and cause peripheral vasodilation

163
Q

pt with hypercalcemia has a normal PTH hormone level. How do you interpret?

A

Dx hyperPTH

IF parathyroid function was appropriate PTH would be low

164
Q

RFs for latent TB to progress to active TB?

A 
Lung CA
T2DM
alcoholism
contact w/ active TB person
pt on immunosuppressant 
parenchyma lung dz (COPD, silicosis)
165
Q

goal Hgb range for pts with CKD?

A

10-12

166
Q

characteristic lab findings in intrahepatic cholestasis of pregnancy?

A

elevated total bile acids
NL GGT
NL coags

167
Q

which intervention for CTS has the best evidence to delay need for surgery

A

Steroid injection

Although this isn’t first line

168
Q

work up for microhematuria (3-5 cells) in a male

A

RVUS
Cytology
Cystoscopy

169
Q

Valvular abnormality in Marfans

A

Mitral valve prolapse
This can cause aortic insufficiency
Can lead to aortic root dilation

170
Q

toddler refuses to eat meals, only cookies. What do. you do?

A

Provide healthy snacks for all meals and end the meal if kiddo won’t eat
Do not offer food as a reward

171
Q

pt has mitosis, unilateral pupil mitosis, decreased sweating. Next?

A

CXR
C/f Horner’s syndrome
Looking for pan coast superior sulcus tumors of the lung

172
Q

most likely cause of hearing loss in newborns?

A

genetic dz

173
Q

What helps iron absorption?

A

Acidic environments (ie take with OJ)

174
Q

most tines improves with TOP therapy, except?

A

tines capitis

175
Q

Tx for antiphospholipid syndrom in a gravid pt?

A

ASA and heparin

176
Q

when is dizziness concerning

A

when it is associated with other neurologic syx (diplopia, difficulty with speech, weakness, etc)

177
Q

Ocular misalignment on cover/uncover test when the corneal light reflex is deviated from normal position to slightly nasal to mid pupil. Misaligned eye then moves to fixate on a held object when the opposite eye is covered, but back to normal when other eye is uncovered

A

Strabismus

178
Q

slutty dude with chlamydia won’t tell you name of partners. how do you expedite tx of partners?

A

Make Rx for patient + Rxs for expedited partner therapy (written to EPT)

179
Q

best pre-treatment to prevent contrast induced nephropathy when undergoing cardiac cath?

A

hydration with sodium bicarb fluids

180
Q

After AOM in a toddler parent noes changes in hearing. Exam TM is retracted and tympanogram shows a flat tracing. Next?

A

Unilateral serous otitis is unlikely to cause delayed language
Observe (no antihistamines or steroids)
if hearing loss >3 months –> tympanovstomy tubes

181
Q

most effective at helping with nipple pain in Breast feeding?

A

Education on positioning

182
Q

preferred ankle support in a pt with a sprain

A

Simi rigid stirrup brace (air cast)

OR lace up support

183
Q

Tx for meth user that wants sobriety?

A

CBT

No FDA approved meds

184
Q

Peds nurse has fever, faint maculopapular irregular reticulate exanthema over thighs and upper arms. Symmetric synovitis in several DIP, PIP, MCP joints, wrist and elbow. Dx?

A

Parvo B19
Erythema inectiosum
common in younger women

185
Q

Do you have to stop statin in cirrhosis pts?

A

No, the CV benefit outweighs risk

186
Q

Pt is now asplenic. Which tax does he need?

A

Pneumococcal
Meningococcal
Hib

187
Q

Ab specific to RA?

A

anti CCP Ab

188
Q

Young pt has OAB/Urge incontinence. Best 1st line tx?

A

Pelvic floor exercises

can be more effective than medications

189
Q

What tx can make grave’s ophthalmopathy worse?

A

Radioactive iodine

hyperthyroid syx

190
Q

22 y/o FOOSH and has torn RTC tendon on MRI. Next?

A

Surgery

Acute tears need to be repaired within 6 weeks

191
Q

Pap: NILM, HPV +, non typable. Next?

A

Pap in 1 year

IF she were HPV 16 or 18 + –> colposcopy

192
Q

Imiquimod (Aldara) is FDA approved treatment for?

A

External anogenital warts

193
Q

septic pt blood cx + for strep Boris. Now what?

A

Needs c-scope to r/o CRC

ECHO to r/o endocarditis

194
Q

Interventions for hyperK rapidly

A

Sodium bicarb
insulin + glucose
Albuterol
- lokelma works but isn’t rapid

195
Q

how do you counsel about nicotine replacement therapy?

A

NRT usually doubles the smokers chances of quitting

196
Q

when can kids drink cows milk?

A

1 y/o +

not enough vitamin E, iron, essential fatty acids and overburdens them with too much protein, Na, K

197
Q

Leading cause of death in first 30 days s/p bariatric surgery

A

PE

198
Q

What age is a H&H indicated at a WCC?

A

12 months

199
Q

What is important to be aware of as far as pharmacokinetics in geriatric patients?

A

Increased % of body fat
Decrease in lean body mass
Causes an increased distribution of fat soluble drugs such as diazepam
Increases half life of fat soluble drugs

200
Q

Medication that improves claudication in PAD patient

A

Cilostazol (Pletal)

Antiplatelet therapy reduces risk of MI but doesn’t affect claudication

201
Q

what is diagnostic of SBP in a febrile cirrhotic?

A

paracentesis fluid with PMNs >250

202
Q

young adult recently on camping trip returns with fever, myalgias, and pink blanching rash that includes palms/soles. dx tx?

A

Ricketsial dz- likely rosy mountain spotted fever

Tx doxy 100 BID

203
Q

pt climbing mountain gets HA nausea and progresses to ataxia and confusion. Next?

A

give oxygen and immediate descent

dx - high altitude cerebral edema

204
Q

thromboses hemorrhoid, next step for relief

A

excision

steroids help but not enough apparently

205
Q

RFs for Macular degeneration

A

smoking

HTN

206
Q

which pap cytology finding has the highest risk of developing CA?

A

Atypical glandular cells not otherwise specific (AGC-HOS) - CA rate of 17%
HSIL - 3% CA rate

207
Q

What does a p value of <0.05 mean?

A

There is a 5% likelihood that the results occurred by chance alone

208
Q

6 y/ohas fever, joint pain, colicky belly pain after a viral URI. Has a palpable dark purple rash. Dx

A

Henoch-schonlein purpura

209
Q

Tx that help prevent postherpetic neuralgia

A

antiviral (acyclovir, famiciclovir)

low dose TCA may also help (amitriptyline)

210
Q

what other lab tests help confirm vit b12 deficiency

A

elevated methylmalonic acid and homocysteine

precursors that require b12 for metabolism

211
Q

65 y/o
weakness, fatigue, weight loss, recurrent infections, bleeding
Hepatosplenomagaly, LN
Anemia, monoclonal IgM peaks, Bence-Jones protein
Xray w/o lytic lesions
Bone Marrow bx –> lymphocytes
Dx?

A

Waldenstrom’s macroblobulinemia
Non Hodgkins lymphoma has similar presentation, but no monoclonal gammopathy or Bence-Jones protein. Bx would have had distinctive malignant lymphocytes

212
Q

19 y/o F runner w/ constant groin pain. Limited hip ROM on flexion and internal rotation of hip. Xray NL. Dx?

A

Stress fx of R femoral neck

213
Q

Tx for labial adhesion 4 y/o that has frequent UTIs

A

TOP estrogen cream

Makes them prone to UTIs

214
Q

BMI for anorexia?

A

17 and under

215
Q

Alzheimer’s pt on cholinesterase inhibitor is wandering and pacing and family is asking for more medications

A

No additional treatments

not much will help the wandering

216
Q

Alternative therapy for pt that can’t tolerate bisphosphonate that would be the most effective

A

Zoledronic acid (Recast)

217
Q

F patient tested positive for chlamydia. What do you counsel

A

Need to treat her and every partner she has had in the past 60 days
Needs to use barrier method for 7 days after treatment
Failure to treat her would increase her risk of infertility later

218
Q

when is morning sickness considered abnormal?

A

After 9 weeks of gestation

219
Q

Most likely to cause seizure in elderly pt?

A

CVA, especially hemorrhagic cva

220
Q

surgical therapy for unilateral tremor and dyskinesia in Parkinsons

A

Thalamotomy and pallidotomy

221
Q

characteristic lab finding in pyloric stenosis

A

hypochloremic alkalosis

222
Q

The accuracy of a Mini mental exam is affected by?

A

Education level of the pt

223
Q

what antibiotics can increase the risk of statin toxicity?

A

Erythromycin or clarithromycin

224
Q

what causes rhinitis medicaments?

A 
IN decongestants (ie phenylephrine)
causes rebound congestion
225
Q

Elderly woman has nighttime incontinence, wakens from sleep with intense desire to void but doesn’t make it to bathroom, dx and mech?

A

Urge incontinence

caused by detrusor instability

226
Q

what measures the severity of DKA

A

pH
Bicarb
AG
Mental status

227
Q

pt has a lesion suspicious for melanoma. Which bx technique would you do?

A

elliptical excision
Only get a punch bx if the size of the lesion is too big for excision because there is a risk of missing the malignant cells

228
Q

Pt at term is admitted for HTN and proteinuria. Next day she has a drop in PLT and LFTs double. Now what?

A

Induce labor if cervix favorable
c-section if not
HELLP syndrome

229
Q

Toddler bangs his head when he is frustrated. Has some swelling on exam. What do you tell parent?

A

They typically outgrow this by age 3

230
Q

28 wk preggo is in a MVA and on a backboard in c-collar. Until her spine is cleared, how do you position her?

A

supine w/ uterus manually deflected laterally

try to prevent uterus from compressing great vessels

231
Q

Start bisphosphonate based on which FRAX score?

A

10 year risk of major fracture is 20%+
OR 10 year probability of hip fx is 3%+
T score -2.0 is osteopenia

232
Q

which fluoroquinolone should not be used for UTI?

A

Moxifloxacin

Poor urinary concentration

233
Q

Most common type of adverse event in a hospitalized pt > 65

A

Drug related events

NOT wounds or falls

234
Q

what is considered an adequate trial of an antidepressant?

A

4-6 weeks

235
Q

Compared to po opioids, epidurals in labor increase rate of?

A

prolonged second stage of labor
increased rate of instrument assisted vaginal deliveries
increased likelihood of maternal fever
NOT c-section

236
Q

What does a USPTF D recommendation mean?

A

Moderate or high certainty that the service offers no benefit or that the harm outweighs benefit

237
Q

Which type of mood stabilizers can induce w/d is stopped abruptly

A

Venlafaxine (Effexor)
Much more severe than with SSRIs
syx - agitation, anorexia, confusion, impaired coordination, seizures, sweating, tremor, vomiting
Make dose changes gradually

238
Q

Pt has RA syx but ANA and rF negative, elevated esr. Now what?

A

Still has RA
Clinical diagnosis counts
ANA + in 35% of RA pts

239
Q

What medications can help prevent contrast induced renal failure

A

N-acetylcysteine

Sodium bicarb

240
Q

Most common cause of proteinuria in children?

A

Orthostatic proteinuria

60% of asymptomatic proteinuria in kiddos

241
Q

What helps to relieve pain in a osteoporotic fx?

A

SQ or IN calcitonin

242
Q

80 y/o M with heel pain that gets worse as day progresses. Xray normal. Dx?

A

Fat pad atrophy

243
Q

what imaging should you get to confirm if T2DM has osteomyelitis?

A

MRI

NOT CT or tagged WBC study

244
Q

When do you give tpn?

A

when patient has poorly functioning GI who cannot tolerate enteral feeding

245
Q

Most effective Rx for head lice?

A

Malathion (Ovide)

Less toxic than lindane. More effective than permethrin

246
Q

Most common stress fx in kiddos?

A

Tibia

Actually most common stress fx in kids and adults (about 50%)

247
Q

Pt has osteoporotic vertebral compression fx. On oxycontin and NSAIDs, what else is helpful in pain control?

A

Calcitonin either IN or SQ

pain relief within a few days

248
Q

2 y/o is flat footed with weight bearing but with toe standing and sitting the arch appears. Now what?

A

Reassure the parents
Only pathologic if it is painful
Usually spontaneously resolve after 1 year of walking

249
Q

Tx for overt hyperthyroidism in 1st trimester

A

Propyltiouracil

Cannot use methimazole in 1st trimester. Cannot observe d/t hyperthyroid having Ads on mother and fetus.

250
Q

Formula for NNT

A

1/ARR

251
Q

Syx of Mag toxicity

A

respiratory depression

Reason to check reflexes

AFP boards (5 decks)

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