Wrong AAFP Questions Flashcards
Absolute contraindications to ECT
None
Treatment of pneumonia in children
- Outpatient abx appropriate if child does not have toxic appearance, hypoxemia, signs of respiratory distress, or dehydration
Management of midshaft posteromedial stress fractures
- Relative rest from running and avoiding other activities that cause pain
- Pneumatic stirrup leg brace during treatment
Most appropriate screening test for late-onset male hypogonadism
Serum total testosterone
Management of low TSH in patient being treated for hypothyroidism
Decrease levothyroxine dosage
Management of plantar fasciitis
First-line: NSAIDs and ice, over-the-counter heel inserts
Most accurate test for detecting ACL tear
Lachman test
Colon cancer screening for patients with one first-degree relative diagnosed with colorectal cancer or adenomatous polyps before age 60, or at least 2 second-degree relatives with colorectal cancer
- Begin at age 40 or 10 years before the earliest age at which an affected relative was diagnosed
- Rescreen every 5 years
Medications associated with drug-induced pleuritis
Amiodarone Bleomycin Bromocriptine Cyclophosphamide Methotrexate Minoxidil Mitomycin
Treatment of wide-complex tachycardia in patients with WPW syndrome
Procainamide
Treatment of nursing home-acquired pneumonia
Antipseudomonal cephalosporin, extended-spectrum beta lactam, or antipseudomonal carbapenem
+
Antipsuedomonal fluoroquinolone or aminoglycoside
+
Anti-MRSA agent (linezolid, vancomycin)
Treatment of depression in pregnancy
SSRIs (except paroxetine)
Dysuria, frequency, and pyuria with no bacterial growth on culture
STI such as Chlamydia
Cautious gait with abducted arms and legs, careful “walking on ice” movements, wide-based stance, and “en-bloc” turns
Visual impairment
Intervention for anorexia nervosa
Family-based treatment
Aspirin use for reduction of ischemic strokes
Recommend in women ages 55-79 when potential benefit outweighs potential harm
Aspirin use for reduction of MIs
Recommend in men ages 45-79 when potential benefit outweighs potential harm
Asthma medication that should not be used as monotherapy
Long acting beta2-agonists
Primary treatment for symptomatic mitral valve prolapse
Beta blockers
Prophylaxis for acute mountain sickness in patients with sulfa allergy
Dexamethasone
Most commonly implicated drug in interstitial nephritis
Antibiotics (penicillins, cephalosporins, and sulfonamides)
Supplement useful in treating varicose veins
Horse chestnut seed extract
Contraindications to breast feeding
- Active HSV lesions on the breast
- Active maternal TB
- Administration or use of radioactive isotopes, chemotherapeutic agents, “recreational” drugs, or certain prescription drugs
Most common cause of erythema multiforme
Herpes simplex virus
Treatment of pyogenic tenosynovitis
Splinting and oral antibiotics
Greatest risk factor for AAA
Cigarette smoking
Which tinea infection in children requires systemic antifungals?
Tinea capitis
Adverse effects of PPIs
- Increased risk of CAP and C. diff
- Decreased absorption of vitamin B12
- Decreased calcium absorption
Most effective treatment of chronic plaque psoriasis
High-potency corticosteroids
Most effective adjunctive therapy for patients with unipolar depression who fail to respond with single antidepressant
Lithium bicarbonate
Presentation of malaria
- Recent travel history, prodrome of delirium or erratic behavior, unarousable coma following a generalized convulsion, fever, and lack of focal neurological signs in presence of diffuse, symmetric encephalopathy
- Peripheral blood smear: normochromic, normocytic anemia with P. falciparum trophozoites and schizonts involving erythrocytes
Recommendations for induction of labor based on fetal size
- 4500 g in women without diabetes
- 5000 g in women with diabetes
Treatment of cutaneous erythasma
Topical or oral erythromycin
Treatment of chronic paronychia
- Topical corticosteroids
- Avoiding immersion of hands in water
- Emollients
management of thrombosed external hemorrhoid
Thrombectomy under local anesthesia
Hemoglobin goal in patients with CKD and anemia
10-12 g/dL
Symptoms of asthma with normal pulmonary function tests except for flattening of inspiratory loop
Vocal cord dysfunction
Empiric antibiotic regimen for Neontal sepsis
Ampicillin + cefotaxime
Next step in asthmatic child receiving albuterol and corticosteroids with no improvement
IV magnesium sulfate
Safe medication to treat patient with diabetes who also has renal impairment
Glipizide (Glucotrol)
Treatment of essential tremor in patients intolerant to beta blockers
Primidone (Mysoline)
First-line treatment for urge incontinence
- Pelvic muscle exercises
- Anticholinergic therapy
What symptom is consistent with spinal stenosis but not herniated vertebral disc?
Pain relieved by sitting and worsened with standing (opposite for disc herniation)
Vitamin D recommendation in infants, children, and adolescents
400 IU/day starting within first 2 months of birth in infants
Effect of weight reduction on cardiovascular mortality
None
Effective strategy shown to increase success of voiding trial in hospitalized patients with urinary retention
Initiation of alpha blocker at time of urethral catheter insertion
Most common infectious agent in cat bites
Pasteurella multocida
Management of pneumothorax <20%
If patient has few symptoms, followup should include CXR at 24-48 hours
Other allergies associated with latex allergy
Avocados, bananas, chestnuts, and kiwi
Which cardiac arrhythmia ha s been associated with high-dose methadone use?
Torsades de pointes
Treatment of a-fib
Low risk: aspirin
Moderate-high risk: warfarin
Treatment of persistent urethritis in males
Azithromycin or doxycycline
+
Metronidazole
Bilateral nipple pain with and between feedings after initial soreness has resolved
Candida infection
Treatment of Bartonella henselae infection
Azithromycin, rifampin, ciprofloxacin, TMP-SMX, or gentamicin
Causes of macroglossia
- Developmental conditions (Down syndrome)
- Tumor (hemangioma or lymphangioma)
- Metabolic diseases (amyloidosis)
- Endocrine disturbances (acromegaly or cretinism)
Treatment of mild-moderate allergic rhiniits
Intranasal corticosteroids
Treatment of bronchiolitis
Supportive care
Management of prostate cancer in men >65 wth small-volume, low-grade disease and 10-15 year life expectancy
Watchful waiting
Threshold for prophylactic platelet transfusion
10,000
Which medications have the best evidence for preventing hip fracture?
- Zoledronic acid
- Risdronate
- Alendronate
Which medications have been shown to be an effective adjunctive therapy for venous ulcers?
- Pentoxifylline (Trental)
- Aspirin
Initial treatment of acute low back pain without sciatic features
Return to normal activities
Initial study for patient of any age with chronic neck pain and no history of trauma, malignancy, or surgery
Complete cervical spine series
Which NSAID should be avoided in older patients according to the Beers Criteria?
Indomethacin
Preferred initial test for renovascular hypertension in patients with impaired renal function
Duplex Doppler ultrasonography
Initial dose of warfarin in elderly or patients who have conditions such as heart failure, liver disease, or history of recent surgery
Max dose = 5 mg
Treatment of medial third clavicular fractures in pediatric patients
Sling and swathe (figure-of-8 apparatus)
Treatment of boxer’s fracture
Ulnar gutter splint
Target glucose level in critically ill diabetic patient
140-180 mg/dL
Treatment of cholestasis of pregnancy
Ursodiol
Management of rosacea
- Avoidance of precipitating factors
- Use of sunscreen
- Oral metronidazole, doxycycline, or tetracycline
Prognostic factor for neurologic recovery in comatose patient
Myoclonic status epilepticus at 24 hours
First-line treatment for osteoarthritis in patient with renal impairment
Acetaminophen
Initial treatment of tendinopathy of the posterior tibial tendon
Immobilization in cast boot or short leg cast
Infant 1-3 months old with tachypnea, staccato cough, and no fever + eosinophilia
Chlamydial pneumonia
Management of heparin-induced thrombocytopenia
Discontinuation of heparin and treatment with non-heparin anticoagulation
Reliable test to rule out adrenal insufficiency
Morning serum cortisol
Presentation of polymyalgia rhuematica
Bilateral shoulder or hip stiffness and aching for at least one month
Topical postprocedure care for surgical wounds
Petrolatum ointment
Treatment of chronic back pain
Analgesics, multidisciplinary rehab, acupuncture
Treatment of idiopathic sudden sensorineural hearing loss
Oral corticosteroids; hyperbaric oxygen therapy within 3 months of diagnosis
Preoperative tests for low-risk surgeries
None
Criteria for mild persistent asthama
- Symptoms more than 2 days per week but not daily
- Use of inhaler more than 2 days per week but not daily
Diagnosis criteria for diabetes mellitus
- Hemoglobin A1c 6.5% or higher
- Fasting plasma glucose level of 126 mg/dL or higher
- 2 hour plasma glucose level 200 mg/dl or higher
- Random blood glucose 200 mg/dl PLUS symptoms of diabetes
Dizziness exacerbated by scuba diving, sneezing, coughing, heavy weight bearing, or straining
Perilymphatic fistula
Recommended imaging study for possible septic arthritis
Ultrasonography
Definition of female athlete triad
- Energy deficiency with or without disordered eating
- Amenorrhea/menstrual disturbances
- Bone loss/osteoporosis
Diagnostic test for renal colic
CT
Management of asymptomatic aortic stenosis
Watchful waiting
Treatment of lichen sclerosus
High-potency topical corticosteroids
Most accurate imaging study for assessing early osteomyelitis
MRI
Preferred treatment for venous thrombosis during pregnancy
LMWH
Effective medications for secondary prevention of cardiac events
- Aspirin
- Beta blockers (after MI)
- ACE inhibitors in patients at high risk after MI
- ARBs in those with CAD
- Amiodarone in those who have had an MI and have high risk of death from arrhythmias
Exposure of hantavirus comes from excretion of what animal?
Mice
Recommended age limit for over-the-counter cough and cold products
2 years and older
Diagnosis of whooping cough
Nasopharyngeal culture + PCR testing
Preferred opioids for use in patients with ESRD
Fentanyl & methadone
Centor Criteria
1) absence of cough
2) swollen, tender, anterior cervical lymph nodes
3) Temperature >38.0
4) tonsillar exudate and swelling
+ 1 point for patients ages 3-14
-1 point for patients over age 45
How do you estimate glucose level from hemoglobin A1c?
Hgb A1c of 6.0% = 120, then add 30 mg/dl for each % point increase
Treatment of stable person with supraventricular tachycardia
Adenosine 6 mg by rapid IV push
Treatment of unstable person with supraventricular tachycardia
Synchronized cardioversion
Lab for diagnosing vitamin D deficiency
25-hydroxyvitamin D
Ottawa Ankle Rules
X-rays required if:
1) pain in malleolar zone and bone tenderness of either distal 6 cm of the posterior edge or the tip of either the lateral or medial malleolus
2) Inability to bear weight for 4 steps immediately and in the ER
Prophylaxis for traveler’s diarrhea
Rifaximin
Next step following identification of adrenal mass
Adrenal function assessment with overnight dexamethasone suppression test; 24-hour fractionated metanephrines and catecholamines
Decontamination treatment of choice for most medication ingestions
Single dose of activated charcoal within 1 hour of ingestion
Indications for gastric lavage, cathartics, or whole bowel irrigation for medication ingestions
- Medications that are poorly absorbed by activated charcoal
- Medications in sustained-release or enteric-coated formulations
Best pharmacologic treatment of gestational diabetes
Twice daily combination of intermediate-acting insulin and short-acting insulin while continuing diet & exercise program
Empiric treatment of endocaritis by gram-positive coccus
Vancomycin + gentamicin (if patient has no prosthetic valves)
Diagnostic criteria for polycythemia vera
Major criteria
- increased red cell mass
- normal O2 saturation
- presence of splenomegaly
Minor criteria
- elevated vitamin B12 levels
- Elevated leukocyte alk phos
- Platelets >400,000
- WBC >12,000
What does Medicare Part A cover?
Inpatient care in hospitals and skilled nursing facilities, hospice, and home health services (but not custodial or long-term care
What does Medicare Part B cover?
Outpatient physician services, including office visits and home health services
What does Medicare Part C cover?
Combines part A and B coverage, offered by private companies
What does Medicare part D cover?
Prescription drugs (D for drugs!)
Nodule at fourth finger with pitting or dimpling of the skin
Dupuytren’s contracture
Indications for venous thromboembolism prophylaxis in hospitalized patients
Patients over age 40 who have limited mobility for 3 days or more and have at least one of the following: acute infectious disease, NYHA class III or IV heart failure, acute MI, acute respiratory disease, older age, recent surgery or trauma, immobility or paresis, obesity, central venous catheterization, inherited or acquired thrombophilic disorders, varicose veins, or estrogen therapy
Initial treatment of status epilepticus
Lorazepam followed by phenytoin
Physical exam finding of head and neck associated with diabetes mellitus
Sialadenosis (bilateral noninflammatory enlargement of the parotid gland)
Treatment of acute dystonic reaction
Diphenhydramine or benztropine
Most appropriate route of epinephrine administration in anaphylactic reactions
Intramuscular
Management of asymptomatic placenta previa seen on ultrasound at 20 weeks gestation
Repeat ultrasound at 28 weeks
Small bony avulsion visiible on lateral view of wrist x-ray
Triquetral fracture
Treatment of drug-induced vasculitis
- Supportive care if mild
- Corticosteroids if severe
Treatment of narcolepsy
Methylphenidate and other stimulant drugs
Most common causes of hypercalcemia
- Hyperparathyroidism
- Malignancy
Lab for monitoring LMWH therapy
Anti-factor Xa levels
First-line treatment for alopecia areata that affects <50% of the scalp
Intralesional corticosteroid injections
Treatment for alopecia areata that affects >50% of the scalp or children <10
Topical minoxidil
First-line antibiotic treatment for community-acquired pneumonia in a young adult in the ambulatory setting
Azithromycin
Best treatment for lateral epicondylitis
Expectant/conservative management
Treatment of acute paronychia
Topical antibiotics +/- topical corticosteroids
Risk factors for Dupuytren’s disease
Diabetes mellitus
What is Carnett’s sign?
Easing of pain of abdominal palpation with tightening of abdominal muscles
Treatment regimen for HIV positive patients with latent TB infection
Isoniazid daily for 9 months
Treatment of hemodynamically stablePSVT
IV adenosine
Treatment of chronic orthostatic hypotension
Fludrocortisone
Midodrine
Physostigmine
Initial treatment of peripheral artery disease without CHF
Cilostazol
Osteoporosis medication with best evidence for prevention of both vertebral and hip fractures
Zoledronic acid
Most common cause of proteinuria in children
Orthostatic proteinuria
Most effective treatment of head lice
Malathion
How is scabies predominantly transmitted?
Direct personal contact
Treatment of acute otitis externa
Ciprofloxacin 0.3%/dexamethasone 0.1% topically
Treatment of group B strep in penicillin-allergic patients
Cefazolin
Which osteoporosis medication can be used to treat pain associated with acute or chronic vertebral fractures?
Calcitonin-salmon (Miacalcin)
First-liine therapy of gestational hypertension
Labetalol
Treatment for hypoactive sexual desire disorder
Topical testosterone
Treatment of Bell’s palsy
Corticosteroids
Prevention of opioid-induced constipation
Polyethylene glycol
Lactulose
Magnesium hydroxide
Senna
Normal time required for Get Up and Go test
10 seconds
Most common cause of stillbirth
Placental abnormalities and obstetric complications
Target uric acid goal for patients with gout
5-6 mg/dL
What parameters is blood pressure classification in children based on?
Sex, height, and age
Indications for tympanostomy tubes in child with recurrent otitis media
3 episodes of AOM in the past 6 months
OR
4 episodes within the pats year with at least one episode in the past 6 months
Prophylaxis of Lyme disease
200 mg of doxycycline within 72 hours of tick removal if tick is engorged or is suspected to have been attached for at least 36 hours
Vilaceous, polygonal papules that are pruritic and affect skin and oral mucosa in patient with hepatitis C
Lichen planus
American Geriatrics Society recommends HbA1c goal of __ for individuals with very complex health problems or poor health
<8.5%
Opioid choice in patients with end stage renal disease
Fentanyl
Medical conditions that decrease responsiveness to warfarin
Hypothyroidism, visceral carcinoma, increased vitamin K intake, diabetes mellitus, and hyperlipidemia
Conditions that increase responsiveness to warfarin, the INR, and the risk of bleeding
Vitamin K deficiency caused by decreased dietary intake, malabsorption, scurvy, malnutrition, cachexia, small body size, hepatic dysfunction, moderate to severe renal impairment, hypermetabolic states, fever, hyperthyroidism, infectious disease, heart failure, and biliary obstruction
TB screening test in patient with history of BCG vaccinatino
Interferon-gamma release assay
Antidepressant indicated for both depression and chronic pain
Duloxetine
If you suspect pityriasis rosea, what other disease should you rule out first?
Syphilis
Antibiotic choice for neonatal sepsis
Ampicillin + cefotaxime
Treatment of ueitis
Topical corticosteroids
Treatment of chronic midsubstance Achilles tendinopathy
Eccentric exercise
What EKG abnormality would dictate use of pharmacologic stress test as opposed to an exercise stress test?
Left bundle branch block
Oxygen duration recommendations in patient with COPD exacerbation who did not require oxygen therapy prior
Reassess in 3 months
Contraindication for methylergonovine in postpartum hemorrhage
Hypertension
Contraindication for carboprost tromethamine in postpartum hemorrhage
Asthma, hepatic disease, renal disease, or cardiac disease
Colon cancer screening recommendations for patiens with ulcerative colitis
Screening starting 10 years after initial diagnosis and continuing every 2-5 years (based on findings)
