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AFP boards > Q Bank 3 > Flashcards

Q Bank 3 Flashcards

1
Q

viral uri syx with abrupt onset?

A

influenza like illness

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2
Q

Nonthrobocytopenic palpable purpura
colicky abdominal pain
Arthritis
dx?

A

Henoch-Schonlein purpura

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3
Q

At what heights should you think about Marfan’s?

A

70 - female
72 - male
+ 2 other common findings (ie myopia, long arms)
Strongly consider ECHO for MVP

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4
Q

which bed wetting treatment has highest cure rate and lowest relapse rate?

A

Bed alarms

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5
Q

When can you get a false positive on UDS?

A

Eating poppy seed muffins

It only takes one

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6
Q

Ottawa ankle rules

A

Can’t take 4 weight bearing steps
Get Xray if pain: over malleolar zone, TTP over posterior edge of malleolus or midpoint or base of 5th metatarsal/navicular

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7
Q

Parasitic disease that if untreated leads to cardiomyopathy, heart failure, fatal arrhythmia

A

American trypanosomiasis (Chagas disease)
common to Central America
vector - kissing bug

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8
Q

Long term outcomes of trichomonas

A

infertility, poor birth outcomes

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9
Q

Long term outcome of cysticercosis?

A

epilepsy

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10
Q

Head/neck LN most likely to be cancerous?

A

Supraclavicular

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11
Q

Dosing of RhoGAM

A

If < 12 wks –> 50ug
If >12 weeks –> 300 ug
Give to all Rh - pregnancies with bleeding

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12
Q

most common nutritional deficiency?

A

Iron

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13
Q

28 wk gravid
O-, Ab+
What does this mean?

A

Fetus is at risk of hemolytic dz but only if father is Rh+

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14
Q

Most common complication after Roux-en Y bypass

A

Iron and B12 definciency

NOT dumping syndromes (rare apparently)

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15
Q

1 y/o has microcytic anemia, next?

A

tx w/ po iron
NOT additional bloodwork
If failure to respond then you do a work up

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16
Q

most sensitive method for identifying risk for postoperative bleeding?

A

Bleeding history

NOT coats

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17
Q

Scabies are primarily transmitted through?

A

direct contact

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18
Q

electrosurgical destruction in contraindicated for which type of skin lesion?

A

Melanoma
(also use of pacemaker)
Basal cell can be treated with electrosurgery

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19
Q

How to drain a felon?

A

High lateral incision OR volar longitudinal incision OR high lateral incision

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20
Q

young adult w/ fever, fatigue, weight loss, diarrhea x 2 months with palpable mass in RLQ. most likely dx?

A

Crohn’s

this pattern of syx is characteristic when Crohn’s affects the distal small intestine (regional enteritis)

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21
Q

pt has erythroderma and fever, leukocytosis with 20% EOS, elevated LFTs. Dx?

A

Drug run with eosinophilia and systemic symptoms (DRESS syndrome)
stop offending meds - anti seizure meds, allopurinol
Start steroids

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22
Q

Characteristic findings in secondary hyperaldosteronism

A 
Sodium retention (decreased Ur sodium)
Increased potassium secretion
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23
Q

preferred imaging for dx of appendicitis?

A 
spiral CT (sensitive 97%, specificity 98%)
NOT US - kid was 15
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24
Q

What happens if you start ACEI in a pt with renovascular HTN?

A

Increased Cr, HyperK+

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25
Q

Fancy name for target rash

A

erythema migrans

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26
Q

Scattered individual purple macules on ankles and wrists. Dx?

A

Rocky Mountain spotted fever

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27
Q

dry scaling dark red rash in groin with an active border and centra clearing. Dx?

A

Tinea cruris

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28
Q

migratory pruritic erythematous population eruption. dx?

A

uticaria

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29
Q

Pt wants to stop Pradaxa and switch to warfarin. How?

A

Start warfarin now and stop dabigatran in 3 days

Dabigatran does raise INR, won’t see the real INR until it has been stopped for 2 days

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30
Q

Mech of action of metformin

A

Inhibit glucose production by liver

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31
Q

Tx for air hunger in hospice pt

A

Morphine
Use haloperidol for n/v and delirium
Use scopolamine for secretions

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32
Q

hypothyroid pt gets preggo. How do you manage?

A

Will need more thyroid hormone
Increase to 9 doses/weekly (take extra dose on 2 days/wk)
Frequent TSH/T4 to guide dosage

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33
Q

Pt with FOOSH, + fx of radius has hyperCa and found to have hyperPTH. Now what?

A

Refer to surgery for parathyroidectomy

Indicated in PTH + fragility fx

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34
Q

Factor V leiden is associated with?

A

DVTs

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35
Q

Infant has conjunctivitis and gram Stan is gram neg diplococci. next?

A

IM CTX

NOT topicals - ppx only

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36
Q

helpful treatment in the common cold?

A

Ipratropium nasal spray (Atrovent)

The only recommended tx to help with colds. Helps with cough and rhinorrhea

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37
Q

when should a preggo get live virus vaccine?

A

immediate post partum

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38
Q

what labs should be checked before starting reclast (bisphosphonate) for osteoporosis?

A

GFR

Ca2+ (hypocalcemia is contraindication to bisphosphonate

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39
Q

pathognomonic exam finding for SCFE?

A

Limited internal rotation of the flexed hip

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40
Q

Osmotic demyelination (central pontine myelinolysis) occurs from too rapid correction of?

A

Hyponatremia

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41
Q

what can help prevent melanoma?

A

Avoiding hormones

High potency broad spectrum sunscreen

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42
Q

pt presents with episodes of hypoxia, no finding on CXR. He is doing basement projects. Dx?

A

Hypersensitivity pneumonitis
Relapsing/remitting episodes that occur after exposure to fungus
tx - avoidance

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43
Q

What other metabolic abnormality if seen in CKD 4

A

HyperPTH

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44
Q

Resevoir for hantavirus?

A

Deer mice

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45
Q

How to calculate negative predictive value

A

True negative/(all those that tested negative)

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46
Q

PCOS increases risk for which carcinoma?

A

Endometrial

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47
Q

cardiac rhythm in anorexia?

A

Brady

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48
Q

Tx for gonorrhea

A

250mg IM CTX

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49
Q

how do you counsel laboring pt interested in regional analgesia.

A

Increases the risk of instrument assisted van delivery

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50
Q

Toddler w/ behavioral probs, on exam long wide protruding ears, elongated face, frontal bossing, macrocephaly. Dx?

A

Fragile X syndrome

At puberty get prominent jaw and macro-orchidist

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51
Q

microbrachycephaly, maxillary hyperplasia, large mouth, prognathism

A

Angelman syndrome

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52
Q

Narrow distance between temples, almond shaped eyes, thin upper lip. Dx?

A

Trader-Wili syndrome

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53
Q

Mechanism of action of sevelamer in CKD pts

A

Blocks intestinal absorption of phosphate which lowers PTH hormone secretion. End goal is to prevent hypercalcemia from secondary hyperPTH

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54
Q

Tx for otitis externa

A

TOP cipro/dexamethasone

this is safe to use even if you are not sure if TM is intact

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55
Q

Tx for childhood OSA

A

Adenotonsillectomy

poor cpap compliance in kids

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56
Q

acidification of the urine is helpful with which type of renal stone?

A

calcium phosphate (struvite stone)
for all others acidic urine promotes formation
cranberry juice or betaine lower urine pH

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57
Q

10 y/o has heel pain during first few minutes of playing sport. Never at walk. No TTP over achilles. + b/l heel pain with passive dorsiflex of ankles. Dx?

A

Calcaneal apophysisitis (Sever disease)
Usually kids 5-11
Tight chilles is pulling on the posterior calcaneus with running/jumping causing micro trauma
NL Xray
Tx avoid painful activity, NSAIDs, ice, stretch

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58
Q

1st line study to dx endometriosis?

A

TVUS

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59
Q

Tx for non inflammatory acne

A

topical retinoids

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60
Q

Tx for mild to moderate inflammatory or mixed acne

A

TOP abx

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61
Q

13 y/o with limp

R hip: decreased internal rotation. Hip externally rotates involuntarily with passive flexion. Dx?

A

SCFE

Needs surgery - no weight bearing

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62
Q

pretibial myxedema is a cutaneous manifestation of?

A 
Graves dz (can present in hypo or hyper thyroid phase)
Increased deposition of mucin
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63
Q

healthy pt, 3 mo h/o hoarseness w/o syx. Next?

A

Laryngoscopy

NOT PPI trial

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64
Q

Who needs US for AAA screening?

A

Men 65-75 who have ever smoked

65
Q

PNA + AMS + hyponatremia. Etiology?

A

Legionella

66
Q

Pt after stenting for ACS is on statin, ASA, AACEI, HCTZ. What is missing?

A

beta block

67
Q

FEV1/FVC 60%, on CT bronchial wall thickening and luminal dilation. Dx?

A

Bronchiectasis

68
Q

Length of DVT ppx after hip replacement

A

35 days

69
Q

Tx for mag toxicity

A

Calcium gluconate

Can use calcium chloride if central line is available

70
Q

why do we prefer methimazole over propylthiouracil for hyperthyroid?

A

propylthiouracil is associated with severe hepatotoxicity

71
Q

best strategy to get long term pain relief from lateral epicondylitis?

A

Modify work/activity

72
Q

GBS ppx intrapartum for pt with PCN allergy (rash, itch)

A

Cefazolin

IF there is a risk of anaphylaxis may consider vanc vs. Glinda

73
Q

CENTOR criteria

A

Fever
Exudate
anterior cervical N
Absence of cough

74
Q

What pain med is contraindicated in compensated cirrhosis?

A

Naproxen
NOT Tylenol
NSAIDs should be avoided in cirrhosis d/t risk of precipitating hepatorenal syndrom
Tyl can be taking in cirrhosis in 2-3g/day doses

75
Q

Tx for corynebacterium minutissimum

A

Erythromycin

AKA erythrasma

76
Q

Pt has trauma syx after an accident two weeks ago. Dx?

A

Acute stress disorder

PTSD when syx present > 1 month

77
Q

pt with exertion claudication, ABI is 1.45. Next?

A

Get MR or CT angio of lower extremities
Can have PAD with ABI > 1.4, this suggests the vessels are so calcified that they cannot be compressed
Need imaging to confirm if PAD is present

78
Q

Pt has chronic cough, worked in navy ship yard for 40 years. worry for?

A

asbestos

79
Q

obese M pt is concerned about increased breast tissue, no glandular tissue appreciated on palpation. Dx?

A

pseudogynecomastia

Increase in subareolar fat 2/2 obesity

80
Q

Most likely to cause hypoglycemia in elderly?

A

Glyburide (sulfonylurea)

More likely to cause hypoglycemia than Glipizide

81
Q

What is Ramsay Hunt

A

Shingles of the facial n.
Can present with palsy
Painful vesicles in side of palate and ipsilateral ear
Can also have vomiting, vertigo
- Tx acyclovir, pred
- HSV wouldn’t typically spread to oral cavity and ear

82
Q

Extracorporeal shock wave therapy to the shoulder is helpful with?

A

Calcific tendinitis

NOT frozen shoulder

83
Q

Risk factors for still birth

A

AMA
smoking > 0.5ppd
congenital anomalies
BMI >30

84
Q

Tx for borderline personality disorder

A

No pharmacotherapy currently available

Dialectic behavioral therapy (DBT) is the most promising

85
Q

1st line for HTN in pregnancy

A

labetalol

nifed (but not IR d/t hypotension)

86
Q

Most common cause of infectious endocarditis?

A

Staph aureus

2nd - Strep viridian’s

87
Q

Kiddo has fever and knee pain with fairly normal exam. Next?

A

CBC, CRP, ESR

88
Q

Tx for low libido in otherwise healthy female?

A

TOP testosterone

Dx if 1) have absence of sexual desire, 2) pt is bothered by it

89
Q

Tx for Jarisch-Herxheimer rxn?

A

Reassurance and antipyretics

90
Q

When should aysx patient with no risk factors be screened for T2DM?

A

45 y/o

91
Q

risk of long term tamoxifen?

A

Endometrial CA

92
Q

pts on letrozole are more likely to have which syx compared to pts on tamoxifen?

A

Myalgias and non inflammatory arthralgia

93
Q

Macrocytic anemia
thrombocytopenia
Neutropenia
Dx?

A

Myelodysplastic syndrome

Blood malignancy with predisposition for leukemic transformation

94
Q

asthma less than once or twice weekly, <2 nighttime awakenings a month

A

Intermittent

95
Q

asthma syx > 2days/week but not daily, nighttime awakening 3-4x/month, SABA >2days/week but not daily. Minor limitation in daily acitivity

A

Mild persistent

96
Q

asthma syx daily, nighttime awakenings weekly but not nightly, daily SABA with some limitations in activity. FEV1 60-80%

A

Moderate persistent

97
Q

asthma syx throughout day, nightly awakenings. SABA multiple times a day

A

Severe persistent

98
Q

1st line tx for depression in pregnancy

A

SSRI
Fluoxetine, sertraline, citalopram
avoid paroxetine

99
Q

What is the concept behind accountable care organizations?

A

Deliver more efficient, high quality services by encouraging cooperation between health care providers

100
Q

Does identifying a mallory weiss tear on EGD in pt with VSS and no active bleeding change management?

A

No can still d/c on PPI

101
Q

what are the timing rules for rotavirus vx

A

Do not start after 15 wks of age

do not doses after 8 months of age

102
Q

when occiput is posterior, pt is less likely to?

A

have a SVD

high risk for c-section of VBAC

103
Q

Tx for mallet fx (unable to extend finger on exam)

A

Splint in full extension x 8 weeks

104
Q

apparently this is a way you can treat depression in a patient with only 2-3 weeks to live

A

Methylphenidate (Ritalin)

SSRIs will take at least 4 weeks where are Ritalin could help within days

105
Q

Tx for bell’s palsy

A

steroids

Antivirals have little benefit

106
Q

Pt given course of azithromycin for CAP. After completing abx CXR shows he still has a single thin-walled cavity in LLL. Tx?

A

Clindamycin
Likely PNA was caused by anaerobes that weren’t covered by azithro
Flagyl isn’t as good as covering pulmonary anaerobes

107
Q

who is legally responsible for notifying a pt about a mammogram result?

A

The facility performing the test

108
Q

Difference between heat exhaustion and heat stroke?

A

Heat stroke is more severe and has some element of CNS dysfunction

109
Q

When does NSGY deceit a intracerebral hemorrhage?

A

When it is a cerebellar hemorrhage
Lower SBP if >180
Reverse INR if > 1.5

110
Q

PNA pt rapidly deteriorates and is intubated. BNP normal. Dx?

A

ARDS

111
Q

Tx for endometrial hyperplasia w/o atypia

A

Progestational drugs
Convert proliferative endometrium to a secretory one causing a withdrawal bleed
Most common is cyclical proverb 14 days/mo. IUDs also work
IF medical management fails then you can explore endometrial ablation or hysterectomy

112
Q

Varicella non immune mom had varicella at 38 week gestation. has healthy infant at 40 weeks. Now what?

A

observe

NO IVIG or vax

113
Q

Tx for travelers diarrhea

A

Azithromycin

Ciprofloxacin

114
Q

Tx for delirium in hospice pt

A

Haldol

115
Q

Why can’t we use ACEI and ARB together?

A

Increases risk of HD

116
Q

most effective drug tor tx and prevention of allergic rhinitis?

A

Flonase

NOT Ipratroprium nasal spray or Zyrtec

117
Q

Most common cause of refractory HTN in middle aged adults

A

Primary hyperaldosteronism
Get a plasma aldo/renin ratio
supported if pt has hypokalemia

118
Q

Most common cause of refractory HTN in elderly adults?

A

Renal artery stenosis

Dx with renal MRA

119
Q

Psych medication associated w/ angranulocytosis

A

Carbamazepine (tegratol)

Get BL CBC, CMP and monitor perodically

120
Q

1st line tx for Alzheimers

A

Donepezil (Aricept)
anticholinesterase inhibitor
Memantine (Namenda) is used as an adjunct with donepezil in moderate to severe cases. Not effective as a monotheray

121
Q

30s adult shoulder pain worse with laying on it. Pain on abduction but no weakness. ROM nl. Dx?

A

Subacromial bursitis

associated with calcific deposits on the supraspinatus tendon

122
Q

What is the benefit of static stretching before a run?

A

None
Slows performance in sprinters
No benefit in muscle injury or soreness

123
Q

Celiac dz increases a pts risk of?

A

Iron deficiency anemia
Osteoporosis (decreased Calcium and Vitamin D absorption)
NOT at increased risk of IBS, diverticulitis or CRC

124
Q

how do you counsel pt about a low carb diet?

A

Better short term weight loss than low fat diet
similar to a reduced calorie diet with normal ratio of macros
low carb does seem to be effective in reducing insulin resistance

125
Q

Pt on antiepileptic drugs wants a contraceptive. Offer?

A

IUD

Can’t do combo contraception d/t antieleptic drugs inducing hepatic metabolism of hormonal contraceptives

126
Q

Pt on Dual anti platelet is undergoing CABG. What do you do with meds?

A

Stop placid 5 days before surgery

127
Q

2 m/o has a misshaped head, NL at birth. What do you do?

A

Counsel parents about positioning (alternate L and R) and tummy time, follow up in 1-2 months

128
Q

Pt has EF of 35% and pHTN. What is the best way to treat her pHTN?

A

maximize her CHF tx
NOT vasodilation or RHC
Vasodilators could actually be harmful in L HF

129
Q

How much time for the get up and go test?

A

10s

Get up, walk 10 feet, turn around, walk back, sit

130
Q

Tx for methanol poisoning?

A

Ethanol

Slows formation of formaldehyde so it can be secreted

131
Q

6 mo WCC only has on testicle. Now what?

A

Urologic referral for surgical exploration
NOT US
Tx unilateral testes at 6-12 m/oage

132
Q

Most effective method for natural family planning

A

Cervical mucos monitoring

133
Q

Stillbirth at 33wk gestation in a white preggo - most likely cause?

A

Placental disease

134
Q

Pt is septic with PNA on Xray and was exposed to flu 2 days ago. Rapid flu negative. Tx?

A

CTX/Azithro/Vanc
oseltavivir
High false negative rate on rapids
Apparently include vanc because septic shock puts him at high risk of MRSA confection

135
Q

1st line HTN tx for pt with CAD

A

Bblocker

136
Q

vertigo + tinnitus or unilateral hearing loss

A

Meniere’s dz

137
Q

Pt with MDD + hypomania

A

Bipolar II

Tx - depakote or Lithium mono therapy

138
Q

Pt with T2DM and multi vessel CAD should get a

A

CABG

139
Q

2 y/o with belly pain and billious vomiting x hours. Get a ?

A

Upper GI series

C/f volvulus

140
Q

Tx c. diff pt with po vanc, not getting better so can add what IV?

A

Flagyl

141
Q

What vent setting is helpful in ARDS?

A

Lower Tidal Volume

142
Q

1st line tx for diabetic peripheral neuropathy

A

TCAs (amitriptyline)

143
Q

characteristic exam finding in pt with pericarditis

A

Pain improves when sitting up and leaning forward

144
Q

Screen for T1DM in kiddos that have what other dx?

A

hypothyroid

Celiac dz

145
Q

kiddo with fever and hip pain, NL Xray, FROM. elevated WBC, ESR. Next?

A

HIP US, c/f septic joint

IF negative, next step would be bone scan

146
Q

Ppx LCC for asymptomatic gallstones is indicated in which pt population?

A

Sickle cell dz
d/t risk of developing pigmented stones
70% of SCD pts have gallstones
if pt develops biliary collic, it is difficult to determine if colic vs Sickling crisis and were high risk of open cases
if ppx removed - better odds they will get a LCC in a controlled way
Can be done at same time as splenectomy
NOT T2DM or Renal transplant

147
Q

Tx for chronic fatigue syndrome

A

CBT
Dx if fatigue x 6 months, impaired memory, post exertion malaise, muscle pain, polyarthralgia, tender LN, sore throat, HA, unrefreshing sleep
CBT and graded exercises are helpful
NOT Ritalin

148
Q

Which medication causes a syndrome similar to SLE (polyarthralgia, friction rub), ANA +?

A

hydralazine
procainamide
most pts improve within weeks with avoidance of drug

149
Q

You extract a metal foreign body that has been present 2 days in the sclera. Rust ring present. Now?

A

See eye doc within 48h

Toxic to the cornea -

150
Q

unvax kid is exposed to kiddo with Hep A. Next?

A

Give hep a Vax
preferred over iVIG because effect lasts longer
Only give family PPX if there is an outbreak and if kiddo is still in diapers

151
Q

ppx abx for ortho procedures

A

Cefazolin

152
Q

Thessaly test is positive in?

A

Medial meniscus tear

Pt stands on one leg and flex knee to 20degree theninteranlly and externally rotate over the knee

153
Q

How long do you check BP when screening for orthostatic while standing?

A

for 3 minutes

154
Q

erysipelas is caused by?

A

Group A Strep (strep progenies)

Tx PCN

155
Q

Which basal cell carcinomas have the highest risk of recurrence

A

Those that are not treated with Mohs surgery
High risk locations - in the “mask” of the face(eyelids, nose, lips, chin, mandible, periauricular, temple, ear), genitalia, hands, feet

156
Q

Elevated AST and GGT?

A

Alcoholic liver dz

157
Q

Tx for tinea wapitis?

A

po griseofulvin

158
Q

skin infection associated with intertrigo?

A

Candida

intertrigo = skin on skin friction –> inflammation

AFP boards (5 decks)

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