https://quizlet.

com/320371864/aafp-questions-flash-cards/

A nontoxic afebrile 4 week old child appears with diffuse crackles and conjunctivitis and
a prominent cough. On WBC there is prominent eosinophilia. Most likely etiological
agent? Chlamydia pneumoniae (atypical pneumonia)

When do we use finesteride? Only if PSA is above 1.5ng/mL and when there is
evidence of BPH

Recommended treatment for a mallet fracture? splinting in extension

Appropriate drugs to manage bipolarism Lithium, valproate, lamotrigine, and some

antipsychotics (including quetiapine)

A young 2 year old presents with her arm pronated and flexed close to her body. She is
resilient to examination of the area. What occurred and how do you fix it? Nursemaids
elbow due to excessive traction and the annular ligament slipping superiorly between
the humerus and radius

Treatment for primary dysmenorrhea? NSAIDs

Two most appropriate first steps to assess a thyroid nodule? ultrasound

TSH level

Which anti-epileptic should be titrated up slowly to avoid S-J syndrome? Lamotrogine

Three best sources of information for providing treatment systematic

reviews, meta-analyses, randomized controlled trials (RCTs)

Flesh colored papules with an erythematous base that are located on the face and trunk
of a 2 day old infant. Dx? erythema toxicum neonatorum

A 70-year-old male with widespread metastatic prostate cancer is being cared for
through a local
hospice. Surgery, radiation, and hormonal therapy have failed to stop the cancer, and
the goal
of his care is now symptom relief. Over the past few days he has been experiencing
respiratory
distress. His oxygen saturation is 94% on room air and his lungs are clear to
auscultation. His
respiratory rate is 16/min.

Best treatment? Morphine

Two causes of bloody diarrhea that are painless? Diverticular bleeding and
angiodysplasia
A patient with persistent severe asthma may present with bruising, why? Inhaled
corticosteroids may increase the risk of bruising in some patients

benign nocturnal limb pains of childhood are what? growing pains- cramping feelings
in calves, arms and shins

Which of the following is not a first line anti-HTN therapy?

ACE inhibitors
B. Angiotensin receptor blockers
C. Calcium channedl blockers
D. β-Blockers
E. Thiazide-type diuretics Beta blockers

Why do we routinely check Na+ levels on patients taking SSRIs? worry about
hyponatremia secondary to SIADH

Four common causes of obstructive lung disease? COPD

bronchiectasis
asthma
CF

A patient presenting with a pericardial rub and pain only relieved by leaning forward
should be given what immediately? NSAIDs (colchicine too)--> first line for
pericarditis

What viral respiratory infection is rarely associated with bacterial co-infection RSV

In a 3 year old with assumed community acquired pneumonia what is the drug of choice
to treat? amoxicillin (older kids get macrolides)

nondisplaced midshaft clavicular fracture should be splinted how? sling

or

figure-of-eight dressing,

OSA in children 2 to 8 is due primarily to what? enlarged adenoids and tonsils

Anemia of CKD is normally treated first line how? oral ferous sulfate

dyspnea, a nondilated left

ventricle with a preserved ejection fraction all indicate what type of heart failure?
diastolic
Slipped capital femoral epiphysis (SCFE) occurs most commonly during when?
adolescent growth spurt with knee pain

Patients with symptomatic peripheral arterial disease should be started on a daily dose
of either _________ or ________ aspirin or clopidogrel

This causes dull or sharp groin pain, which in

some patients radiates to the lateral hip, anterior thigh, or buttock with a positive FABER
or FABIR test hip labral tear

If a patient has bacterial diarrhea that is causing non-bloody stool and no severe
symptoms how do we treat? hydration but NO antibiotics

This vaccine may cause a febrile seizure in a 12 month year old due to fevers that may
spike to 103 degrees MMR (measles component)

A positive valgus stress test of the elbow indicates what? ulnar collateral ligament
injury

Cubital tunnel syndrome is a neuropathy of the ____________ caused by compression

or traction as it passes
through the cubital tunnel of the medial elbow. ulnar nerve

Appropriate pharmacotherapy for someone going thru alcohol withdrawal?

Chlordiazepoxide (want long lasting benzos)

Cows milk is not recommended for infants under the age of what? 12 months

Only required screening in young women prior to starting birth control? BP check

First line treatment of acute MS exacerbation Oral or IV steroids

Patients often present with

agitation and confusion, tachycardia, and elevated blood pressure, as well as a dry
mouth. Treatment? Bento like lorazepam or diazepam~ serotonin syndrome

What decreases the pain of a lidocaine injection? buffering with sodium bicarbonate

What should we do in an asplenic patient with fever? immediately give antibiotics

How do we give PPSV23 and PCV13 to an asplenic patient? 8 weeks apart

What do we give to asplenci patients under 5 y/o? 2 doses of penicillin daily

A 37-year-old graphic designer presents to your office with a history of several months
of radial
wrist pain. She does not recall any specific trauma but notes that it hurts to hold a coffee
cup.
Finkelstein's test is positive and a grind test is negative, and there is tenderness to
palpation over
the radial tubercle.

Which one of the following would be most appropriate at this point? Rest and thumb
spica wrist splint (she has de Quervain's tenosynovitis)

Someone with an elevated WBC who is acutely ill with cellulitis should be treated with
what? Vanc

Patients with chronic illness, diabetes mellitus, cerebrospinal fluid leaks, chronic
bronchopulmonary
dysplasia, cyanotic congenital heart disease, or cochlear implants should receive how
many doses of pneumococcal vaccines? 2

Appropriate workup for infertility? Check luteal progesterone

Hysterosalpingography after for patency

U.S. Preventive Services Task Force (USPSTF) guidelines recommend that

asymptomatic adults with
sustained blood pressure >135/80 mm Hg be screened for what? DMII

Leading cause of death in those with RA? Why? atherosclerotic heart disease
(secondary to chronic inflammatory state)

Two classes of drugs to treat OCD? TCAs

SSRIs

Treatment for postherpetic neuralgia? lidocaine patches

A patient presents with a severe headache they have never had before that has lasted 3
hours. You order a non-contrast CT that is negative, next step? lumbar puncture to
check for xanthochromia

A 62-year-old male comes to your office as a new patient. He has a past history of a
myocardial
infarction and is currently in stage C heart failure according to the American Heart
Association
classification. His ejection fraction is 30%.

Which one of the following medications that the patient is currently taking is potentially
harmful
and should be discontinued if possible?
 A. Diltiazem (Cardizem)
B. Lisinopril (Prinivil, Zestril)
C. Carvedilol (Coreg)
D. Atorvastatin (Lipitor) A. Diltiazem
negative inotropic activity

First line therapy for a fecal impaction in a child? An oral osmotic agent such as
polyethylene glycol 3350 (MiraLax)

When should a child with head lice return to class? immediately only transmitted by
head to head contact

If a nonsmoker has blood tinged sputum what do we do? Smoker? Nonsmoker- Chest
Xray
Smoker- Chest CT

Two main risk factors for esophageal adenocarcinoma? GERD

Obesity

Best medication to treat acute pylo? Cipro (fluorquinolones)

asymptomatic man from iowa who has a milliary pattern of BB sized calcifications on
chest Xray? Histoplasmosis

Immune (idiopathic) thrombocytopenic purpura is an acquired immune-mediated

disorder defined as
isolated thrombocytopenia not found to have another cause. How do we treat it?
Corticosteroids (then do a bone marrow biopsy to rule out a cancerous cause or
find cause)

Drug of choice for treatment of pertussis? Azithromycin

Best initial screening for hereditary hemochromatosis? Ferritin and transferrin

saturation

Terminally ill cancer patients who receive palliative chemotherapy are less likely to
what? Die at home (palliative chemotherapy is not good, more vents and more CPR)

What do we do in the case of a diagnosed case of bacterial meningitis? Treatment

and then prompt prophylaxis of family and close contacts

Foul smelling stool makes you think what? Giardia

Exudative process that causes pleural effusions? Pulmonary embolism (if LDH is
above .67=exudative)
Why don't we give a hormonal releasing IUD to someone with severe cirrhosis?
Increases the risk of hepatocellulalr carcinoma

Which is more successful a detox program or long term methadone/buprenorphine?

Long term pharmacotherapy

The umbilical cord usually has ______ arteries ______ veins 2

1

How do we treat trochanteric bursitis? Corticosteroid injection

What do we do in a patient with well controlled HTN and renal artery stenosis?
continue monitoring their serum creatinine (CT or MRI if worsened and then
stenting)

Treatment of choice for community acquired pneumonia? Azithromycin

A bite on the hand or that involves the lymphatics veins or arteries, what should be
done? antibiotic prophylaxis

Why is Lisinopril first line for ADPCKD? B/c of its renal protective affects

Why don't we prescribe pseudophendrine or phenylephrine in the elderly? can interfere

with BBs, raise BP, and cause urinary obstruction

Three things that reduce iron absorption? Calcium

coffee
tea

Two things that can falsely lower the A1C? hemolytic anemia and acute blood loss
(you lose RBCs so you don't find glucose attached to them)

he volume of distribution of water-soluble compounds such as digoxin is decreased in

older
patients, which means a __________ dose is required to reach a given target plasma
concentration smaller

middle-aged patient with resistant hypertension and hypokalemia Aldosterone

secreting mass (measure peripheral aldosterone and then CT)

The clinical triad of purpura, abdominal pain, and

arthritis is classic for what? How do we treat it? Henloch Schonlein Purpura

No treatment we give acetaminophen for relief of arthritic pain

Infants should roll from prone to supine by ____ months of age and supine to prone by
____ months of age 4

changes of the oral cavity and lips

• polymorphous rash
• bilateral nonpurulent conjunctivitis
• changes in the extremities (erythema followed by desquamation)
• cervical lymphadenopathy
and fever for 4-5 days Kawasaki's disease (need an US to look for aneurysm)

First line therapy for morning N in pregnancy? Vitamin B6 is

recommended as first-line therapy

When can we not give scopolamine patch for pregnant morning sickness? first trimester
(trunk and limb deformities)

Do we need to prophylax those with a pre-existing heart valve problem for dental
procedures? No, not if they are stable only high risk candidates

Best treatment for moderate triglyceridemia? fenofibrate

Approximately 0.3% of patients taking __________ develop agranulocytosis, usually

within the first 60
days of starting therapy. methimazole

Pulsatile tinnitus, unilateral tinnitus, or tinnitus associated with asymmetric hearing loss
is more likely to be associated with a pathologic cause and thus needs what that
bilateral non-bothersome tinnitus does not? Neuroimaging

is a syndrome marked
by motor restlessness. akathisia

A 45-year-old male is seen for a well-demarcated, nonpruritic rash in the right axilla. It is
fine-scaled with a cigarette-paper appearance. The rash has a coral-red fluorescence
under a
Wood's light.

Dx? erythrasma

What post uterine atony agent should

in patients with asthma Carboprost

Treatment for acute parotitis? augmentin

Patient with asymptomatic aortic stenosis should be seen how often for an echo? Every
3-5 years

If a child gets sick and then has lymph nodes that remain swollen hot and red they have
_________. How do we treat it? lymphadenitis

4 weeks of antibiotics and observation

Leading cause of human death worldwide? Ischemic heart disease

What cause of hyperthyroidism will cause an uptake of radioactive iodine? Graves

If the MAP of a patient is below 60 they meet criteria for septic shock, what is the first
thing we do to raise BP? fluid resuscitation

How do we calculate MAP? [(2 x diastolic)+systolic] / 3

After an acute trauma what do we think of in leg pain? Acute compartment syndrome
(order a tissue pressure study)

What testing is recommended prior to beginning pre-exospure prophylaxis for HIV with
Truvada? creatinine clearance calculation
hepatitis B antibody testing
screening for sexually transmitted diseases pregnancy testing
HIV antibody testing

We treat this antibiotic with 60 days of oral fluorquinolones or doxycycline Anthrax

Every patient with croup should receive what? single dose of dexamethasone

What is recommended for women who are breast feeding the first few days after
delivery? 400 I/U/day of Vitamin D until baby is consuming 500 Ml of milk

difference between scar and keloid? Keloid will expand beyond the site of the
wound

What should we monitor during testosterone? Erythrocytosis can occur so we need to

monitor hematocrit

Most common cause of resistant HTN in adults OSA

Where do we place an injection in a patient with rotator cuff tendinitis? Subacromal

space

When do we give an intra-articular injection? Severe OA

A skeletal survey is appropriate in a child 2 years of age or younger suspected of being
what? physical abused

Who do we test for HIV? all patients aged 15-65 years old

If a patient has HTN after 37 weeks gestation what do we do? induce labor

Pathognomonic for narcolepsy? cataplexy- paralysis with laughing

What two medications do we normally give for narcolepsy? sodium oxybate to improve
sleep
Methyphenidate or another stimulant to keep the person awake

Positive CCP indicates what disease? Sole therapy if you can only start one?
Rheumatoid arthritis
Methotrexate

If the FVC is normal or decreased and the FEV1 is decreased, an FEV1/FVC ratio <0.7
means there is an __________ impairment obstructive

If the FVC is decreased and the FEV1 is normal or

decreased the ratio would be >0.7 an ___________ impairment is indicated
restrictive

Screening needed for women 11 weeks to 16 weeks pregnant? UA for

asymptomatic bacteruria

When do we allow patients to return to activity from a stress fracture? When they
are symptom free and have a normal physical exam

Patient with hematospermia should have what workup? STIs

Prostate/PSA
Testicular exam

What medications can be used to treat irritable bowel syndrome? anticholinergics

(amitriptyline) and SSRIs

Most effective therapy for meniscus tear? Physical therapy (meniscectomy is not
shown to be as helpful)

Should we recommended antioxidant therapy? No, has proven to increase all cause
mortality

A 42-year-old male has symptoms of hypogonadism. Which one of the following should
be
ordered first? early morning serum testosterone
What medication is proven to lower the risk of pre term pre-ecclampsia? ASA

In a patient with asymptomatic gallstones what do we do? expectant management

What is the best method to stop primary monosymptomatic enuresis? bed alarms
(wake up and urinate)

Patients with DM should receive what preventative therapy for cardiovascular

protection? moderate intensity statin

Preferred narcotic in patients with end stage renal disease? fentanyl

_____________ is often preceded by minor trauma to the elbow followed by a

nontender, boggy
mass over the olecranon ascetic olecranon bursitis (compression dressing is
treatment of choice, don't aspirate due to risk of infection)

An ankle-brachial index (ABI) is considered normal between what two numbers? 1-1.4

Values less than 1 indicate more severe peripheral artery disease

Values greater than 1.5 indicate incompressible arteries (can't use)

Only Ab shown to be effective in chemoprophylaxis of lyme disease? doxycycline

symptoms of hypoparathyroidism refractory heart failure

tetany
seizures
altered mental status
stridor.

__________ and _______ are useful in the diagnosis and treatment of

narrow-complex supraventricular tachycardias vagal maneuvers
adenosine

Pediatric umbilical hernias normally proceed how? they repair on their own after 3-5
years

Which one of the following medications is associated with a higher risk of death due to
stroke
or sudden cardiac death in patients with dementia?

A. Diazepam (Valium)
B. Fluoxetine (Prozac)
C. Paroxetine (Paxil)
D. Quetiapine (Seroquel)
E. Venlafaxine Seroquel

What medication should be started prior to a vascular surgery statin

Describe what we find in SIADH? You inappropriately secrete ADH meaning you retain
fluid and urinate out Na+, thus the serum osmolality will be low and the urine Na+ high

-treat with fluid restriction

In Bitamin B12 deficient patients what two things are normally elevated?
methylmalonic acid and homocysteine levels

If a patient has hyperkalemia and an abnormal EKG what do we give? IV calcium

Best contraceptive option in someone waiting for a transplant IUD

In patients with IBS what are two treatments to help global symptoms and reduce
abdominal discomfort? SSRIs and TCAs

First line therapy for GAD? SSRIs

Low diffusing capacity of the lungs for carbon monoxide (DLCO) with normal spirometry
indicates a disease process that disrupts gas transfer in the lungs without causing lung
restriction or airflow obstruction such as ___________ PE

Targets individuals who have developed an asymptomatic disease and institutes

treatment to prevent complications Secondary prevention programs

Benzodiazepines in the elderly run the electrolyte risk of what? Hyponatremia

(messes with Na+ channels remember)

α-adrenergic receptor antagonist and is recommended for the treatment of nightmares

in posttraumatic stress disorder (SOR A) prozasin

In a smoker with age related macular degeneration what is the best option?
Smoking cessation (distorted grid lines on Amsler grid)

In a patient with acute pancreatitis what feeding option is preferred? Continuous NG

enteral nutrition

Having multiple exposures on skin often not covered by clothing would be typical of
___________ bedbugs

Definitions of CKD? eGFR <30 mL/min/1.73 m2

a urine albumin to creatinine ratio >300 μg/mg

persistent acidosis or potassium imbalance

non-iron deficiency anemia with a hemoglobin level <10 g/dL

evidence of secondary hyperparathyroidism.

In a patient with peripheral neuropathy and elevated serum protein what is the next
step? serum protein electrophoresis

Any bite or trauma involving a joint must get what? surgical consultation

Confusion Assessment Method (CAM) is a ___________ diagnosis tool delirium

The other tests listed, including the Mini-Mental State Examination, Mini-Cog, Montreal
Cognitive Assessment, and Saint Louis Mental Status exam, test what? chronic
baseline mental status not acute changes

What musculoskeletal problem is improved (not just brief relief) with corticosteroid
injections? trigger finger

All children 9-11 y/o should be screened for which of the following?
A. Anemia
B. Diabetes mellitus
C. Dyslipidemia
D. HIV C. Dyslipidemia

Initial management of a widened, regular, monomorphic QRS? adenosine

_________________ accounts for a significant number of cases of failure to thrive, crib

death, and recurrent pneumonia gastroesophageal reflux

recurrent pneumonia, a low growth curve, a family history of sudden infant death
syndrome, and normocytic anemia are all indicators of what in children? GERD

Common remedy for childhood constipation? miralax (Polyethylene glycol)

What two antibiotics do we give to all patients with SSA and pneumonia? 3rd gen
cephalosporins (regular coverage)
Azithromycin (cover atypicals)

Appropriate test to run in someone you suspect is vitamin D deficient? 25-

hydroxyvitamin D
If someone has _________ we should increase their levothyroxine dose H. pylori or
other GI problems

What vitamin do we give to relieve peripheral neuropathy in TB patients? B6 (dice in

sketchy)

develop because of ulnar nerve compression in the upper extremity, leading to sensory
paresthesias in the ulnar digits and intrinsic muscular weakness. cubital tunnel
syndrome

f atrial fibrillation is converted back to sinus rhythm, the likelihood of the patient staying
in sinus rhythm is best predicted from the diameter of the _____________ left atrium

Treatment of choice for outpatient management of a cancer induced DVT? lovenox

(enoxaparin)

A 36-month-old male has persistent deficits in social communication and interaction

across multiple contexts. He displays restricted and repetitive patterns of behavior,
interest, and activities. this is most consistent with what? autism spectrum disorder

Antipyschotic shown to reduce aggressive behaviors in demented individuals

aripiprazole

A septic patient the glycemic goal is what? <180

Define oppositional defiant disorder angry/irritable mood

argumentative/defiant behavior
vindictiveness

towards someone other than a sibling

Conduct disorder is more severe than ODD why? behaviors are aggressive and
towards animals and they may destroy or steal things

functional dyspepsia may manifest as postprandial fullness or pain and burning in the
epigastrium, how do we treat each? PPF: metochlopramide

Pain: PPI or H2

Unlike radioactive iodine, ___________ has been shown to decrease the risk of
development or progression of ophthalmopathy in Graves disease methimazole

Accepted mood stabilizers used for maintenance therapy in patients with bipolar
disorder include lithium
valproate
lamotrigine
some atypical antipsychotics such as olanzapine, quetiapine, and risperidone

indicates how a positive or negative test correlates with the likelihood of disease
Likelihood ratio

if the patient's endometrial stripe is >_______ you worry about endometrial cancer
25mm

he first-line pharmacologic agent for the treatment of alcohol withdrawal delirium is a

benzodiazepine, such as ________ lorazepam (ativan)

When can we tell an shorter adolescent they will grow taller in one year? Sexual
maturity of 2 or 3
height is equal to bone age

How to differentiate external hemorrhoids from anal fissures? external: can bleed
with trauma but typically cause pain with thrombosis, independent of bowel movements

fissure: pain during and after defecation, caused by passage of hard stool

If someone comes in with MRSA bacteremia and we culture their blood how soon after,
assuming they don't have endocarditis or a prosthetic valve or indwelling line, do we
need to culture their blood? 2-4 days later

GLP-1 agonists are contraindicated in patients with what? thyroid cancer

Coin rubbing is a traditional healing custom practiced primarily where? Southeast

Asia

If someone has a fasting blood glucose of 100-125 what do we do? bring them back in
1-2 weeks to test again (100-125 is impaired fasting blood glucose)

When should iron therapy begin for premature infants who are breastfed? 1 month of
life

A 46-year-old runner presents with left heel pain. The pain has been occurring mostly
with running, but more recently it is painful with walking. On examination there is
tenderness and a palpable nodule on the midsubstance of the left Achilles tendon. Best
treatment? eccentric calf-strengthening exercises.

In 65 year old patient with no comorbidities what is their target BP? <150 (all people 60
or older)

What inflammatory condition contraindicates HCT? gout

positive antinuclear antibody test, and a positive anti-double-stranded DNA test indicate
what? Lupus

preferred treatment for lupus arthritis? Hydroxychloroquine

higher NT-proBNP levels can be caused by what two conditions that may lead to an
inappropriate conclusion of heart failure? low GFR (kidney disease) or a low level
of albumin

Best type of study? randomized, placebo-controlled studies

Options to treat a UTI include nitrofurantoin for ____ days,

trimethoprim/sulfamethoxazole for _____ days, and ______ dose of fosfomycin 5
3
1

At what BMI will weight loss benefit OA in the knees? >25

Post spinal surgery we may see acute urinary retention? How do we treat this? With
indwelling catheter placement for 48-72 hours

All 65 year old patients get what order and duration of pneumococcal vaccines?
Prevnar (13) first and then 12 months later they get Pneumovax

What do probiotics do for infants? antibiotic-associated diarrhea

What two other diseases do probiotics do? Eczema

URI

Cytology without HPV testing is recommended for screening every _____ years for an
average-risk 21-year-old female. 3

Restrictive lung disease commonly seen secondarily to systemic sclerosis Interstitial

lung disease

What type of biopsy should be performed if you suspect melanoma? an excision

biopsy with 1mm to 3mm border around the lesion

What type of adenoma is most likely to become colon cancer? Villous adenoma
(Villainous)

4 criteria for diabetes mellitus type 2? hemoglobin A1c ≥6.5%

a fasting plasma glucose level ≥126 mg/dL

a 2-hour plasma glucose level ≥200 mg/dL

in a symptomatic patient, a random blood glucose level ≥200 mg/dL

A 26-year-old female presents with a 3-month history of abdominal pain,

lightheadedness with standing, and some hyperpigmentation. Her CBC is normal, but a
basic metabolic panel reveals a slightly low sodium level and a slightly high potassium
level.

Which one of the following would be the most appropriate next step in your evaluation of
this patient? ACTH stimulation test

Acute low back pain without radicular symptoms can be treated how? Muscle
relaxants
NSAIDs
Acetaminophen

The greatest reduction in mortality is seen in what A1C in those diagnosed with
diabetes? 7%-8%

Two areas that alkaline phosphatase comes from? bone or liver

If you have a healthy individual with elevated alkaline phosphatase what test do you do?
gamma-glutamyl transferase level (lets you know its from the liver)

Three beta blockers indicated in heart failure? carvedilol, bisoprolol, and metoprolol
succinate (usually start with BB, ACE, or ARB)

First line vasopressor in septic shock Norepinephrine

Polymalgia Rheumatica is best treated how? low dose corticosteroids

4 prophylaxis treatment options for meningitis? ciprofloxacin

azithromycin
ceftriaxone
rifampin

What derm findings are found in dermatomyositis? Macules over the extensor
surfaces of her joints

The typical history includes a high fever in a child with either mild upper respiratory
symptoms or no other symptoms. After the fever breaks a rash appears. Dx?
Roseola infatum

As you perform a pelvic examination you notice a fullness in the left adnexal region that
is mildly tender to palpation. The remainder of the examination is normal. You order
pelvic ultrasonography, which demonstrates a 4×5-cm cystic structure on the left ovary.
There are no internal septations or echogenic internal structures. A pregnancy test is
negative.

What should you do? Redo pelvic US in 8-10 weeks

In a child with ear drainage and tubes what drops should we use? fluorquinolones

A pleural protein to serum protein ratio >0.5 or a pleural fluid LDH to serum LDH ratio
>0.6 suggests an ________ effusion exudative

common cause of exudative effusion? cirrhosis with ascites

Antibiotic needed to treat a puncture wound? Cipro because of pseudomonas and

gram + coverage

Back pain that awakens a child at night is serious, why? Likely cancer/tumor,
infection (osteomyelitis or discitis)

When does diabetes screening occur? Starting at age 40

Contraindication for Metformin? Increased serum creatinine

What is physiologic genu valgus Young kids who knees are touching, reassurance as it
will normalize by 6

combination of arthritis with a typical palpable purpuric rash dx? henoch Schonlein
purpura

Who do we prophylax with lovenox? anyone over 40 who has limited mobility for 3
or more days (infection, surgery, break etc.)

What oral finding is associated with DM2? Parotid gland enlargement

An anxious and agitated 18-year-old white male presents to your office with a 2-hour
history of severe muscle spasms in the neck and back. He was seen 2 days ago in a
local emergency department with symptoms of gastroenteritis, treated with intravenous
fluids, and sent home with a prescription for prochlorperazine (Compazine)
suppositories. The best therapy for this problem is intravenous administration of what?
benadryl or benzotropine (he is having acute dystonia do to dopamine blockade)

Treatment of choice for a moderate to severe ingrown toenail? avulsion or

phenolization followed by antibiotics

Shoulder pain that preceded weakness with no inciting factor is likely _____________.
How do we diagnose it? brachial neuritis
Electromyography and nerve conduction studies
If a mammogram is read as suspicious what should be done? FNA

What medication may falsely depress PSA levels? Finasteride (Proscar)

How do we distinguish Alzheimers from Normal pressure hydrocephalus? NPH- takes

weeks to months
Dementia-Slower onset

Causes of microcytic anemia Iron deficiency Anemia, Anemia of Chronic Disease,

Sideroblastic Anemia, Thalassemia, Anemia of Chronic Disease - Iron locked away in
macrophages

Diabetes medication that will most likely cause weight loss? GLP-1 receptor agonists

A serum bicarbonate level of less than ______ indicates dehydration in a child 17

Test to do in an active GI bleed if an endoscopy is inconclusive? A technetium-99m

blood pool scan

Low dose lung CT is done on who? People 55-80 with 30+ pack year history (even
if they have quit within the last 15 years)

Treatment for multiple myeloma in someone under 65? The standard treatment for
symptomatic patients under age 65 is autologous stem cell transplantation.

Two A rated treatments of chronic low back pain? NSAIDs

Multidisciplinary rehabilitation

Do inhaled corticosteroids increase the risk of fracture? No, pneumonia is

increased though

Initial treatment of C. diff Oral metronidazole- wait for stool sample to come back A
and B toxin positive though

Treatment of epididymitis? Ceftriaxone (Rocephin) and doxycycline

Most common secondary cause of nephrotic syndrome in adults? DM

Say what is occluded in each?

I and AVL changes

V1 to V6

II, III, AVF circumflex

LAD

RCA

Which of the following increases the risk of malignancy?

Systemic scleroderma
B. Systemic lupus erythematosus
C. Sjögren's syndrome
D. Rheumatoid arthritis
E. Dermatomyositis Dermatomyositis

These consist of episodic, sudden, sharp pains in the anorectal area lasting several
seconds to minutes. proctalgia fugax

a nonscarring, shedding hair loss that occurs when a stressful event, such as a severe
illness, surgery, or pregnancy, triggers the shift of large numbers of anagen-phase hairs
to the telogen phase Telogen effluvium

diffuse hair loss that occurs when chemotherapeutic medications cause rapid
destruction of anagen-phase hair. Anagen effluvium

Which atypical antipsychotic causes least weight gain? aripirazole

A 72-year-old white female is admitted to the hospital with her first episode of acute
heart failure. She has a history of hypertension treated with a thiazide diuretic. An
echocardiogram reveals no evidence of valvular disease and no segmental wall motion
abnormalities. Left ventricular hypertrophy is described, and the ejection fraction is 55%.
Her pulse rate is 72beats/min.
The most likely cause of her heart failure is: Diastolic dysfunction due to LVH

Anyone between the ages of 19 to 64 who smoke should receive what vaccination?
pneumococcal
Give it 2 five years apart (immunocompromised, DM, CKD etc.)

Treatment for diverticulitis in someone allergic to flagyl? Augmentin

Most common kind of fecal incontinence in elderly? Overflow

There is pain with physical activity, most commonly in the upper thigh anteriorly dx.?
SCFE

What physical exam finding is limited in SCFE? internal rotation of the hip
is one of the most common causes of bacterial foodborne illnesses, estimated to affect
1 million Americans annually. Commonly in undercooked chicken? Campylobacter
jejuni

AHA states we should monitor stroke patients until their BP is what? >220/>120
(i.e. don't treat)

Why don't we give Carisoprodol (Soma) a prior opioid user? metabolized to a class III
controlled substance

rhinorrhea and pharyngitis, followed in 1-3 days by a

cough and wheezing.

Ronchi, crackles, and wheezes RSV

conjunctivitis, the subacute onset and absence of fever, and the

mild wheezing. There may also be eosinophilia. Chlymadia trachomatis

Women with gestational diabetes have an increased risk for what maternal complication
during delivery? pre-eclampsia

Most pregnant women who have a DVT are given prophylaxis with either ________ or
________ for six weeks postpartum warfarin or LMWH

Only two approved agents to treat diabetes in children? metformin and insulin

It is used to justify medical treatment designed to relieve suffering when death is an

unintended but foreseeable consequence double effect

Angina with ___________ on physical exam is a poor sign and may indicate acute MI
hypotension

is when a screening test finds a disproportionate number of cases of slowly progressive

disease and misses the aggressive cases, thereby leading to an overestimate of the
effectiveness of the screening

is when a screening test identifies a cancer earlier, thereby increasing the time between
diagnosis and death without actually prolonging life. length time bias

lead time bias

If someone has chronic diarrhea and abdominal cramping, but treatment for IBS is not
working, what should you be thinking is the disease? celiac sprue

he chief feature of __________ is a progressive conductive hearing loss

osteosclerosis
Noise induced hearing loss is a ____________ hearing loss sensorineural

When do we give high dose flu vaccines? older than age 65

Which one of the following drugs would be the most appropriate empiric therapy for
nursing home-acquired pneumonia in a patient with no other underlying disease?
Levofloxacin- needs to cover Streptococcus pneumoniae, Staphylococcus
aureus, Haemophilus influenzae, and gram-negative bacteria

Primary amenorrhea should be worked up how?

Secondary amenorrhea should be worked up how? Urine pregnancy, TSH, FSH/LH

Secondary amenorrhea is defined as the cessation of regular menses for 3 months

or irregular menses for 6 months --> do an FSH and LH to monitor them

Primary amenorrhea will have elevated FSH/LH so it won't help

A positive result on the second, but the not the first, step of a two-step Mantoux
tuberculin skin test indicates what? long standing latent infection

In a patient with high TAGs what should we use? fenofibrate

DHEA does not do what? performance or strength

In a woman with primary amenorrhea what can/should we test for pituitary testing?
prolactin

What four tests should try on a female with fatigue? B. An erythrocyte sedimentation
rate
C. A complete metabolic panel
D. A TSH level
E. A pregnancy test

Drugs of choice for nausea in pregnancy? Doxylamine (Unisom) and pyridoxine

(vitamin B6)

Commonly used calcium supplement? calcium citrate

Toradol is what? Ketoralac (IV NSAID)

Best test to assess right ventricular function in patients? echocardiogram

Stretching has no proven benefit for what? Joint contracture (shortening of a joint or
muscle)
Fiber does not help treat ________ IBS

The diagnosis and TREATMENT of PID is __________ clinical

Stimulants for ADHD in adults can cause what main ADR? Increase in BP

What diuretic should be used in those osteoporosis? Thiazides

A 3-year-old male is carried into the office by his mother. Yesterday evening he began
complaining of pain around his right hip. Today he has a temperature of 37.6°C
(99.7°F), cries when bearing weight on his right leg, and will not allow the leg to be
moved in any direction. A radiograph of the hip is normal. What should you do? CBC
and sed rate --> transient septic arthritis of the hip

Plan-Do-Check-Act (PDCA) describes which one of the following? The cycle of

continuous quality improvement

Initial imaging of choice for pancreatitis? Transabdominal ultrasonography

Antibiotic of choice for campylobacter? Azithromycin

We treat gonorrhea with _____________

We treat chlamydia with ___________ ceftriaxone
doxycline/azithromycin

Preferred antibiotic in children 6 months to 5 years with suspected pneumonia? High

dose oral amoxicillin

Treatment of a keloid? Intralesional corticosteroid injection

Preferred form of birth control in those who are overweight The levonorgestrel-
releasing intrauterine system (Mirena IUD)

Preferred form of birth control in those with dysmenorrhea and heavy bleeding The
levonorgestrel-releasing intrauterine system (Mirena IUD)

shortness of breath, paresthesia, and carpopedal spasm are characteristic of what?

Hyperventilation

What can we give those with ICU associated delirium that is not used elsewhere in the
hospital to control people? atypical antipsychotics

Proximal muscle involvement and elevation of serum muscle enzymes such as creatine
kinase and aldolase are characteristic of what? polymyositis
Tramadol should be avoided in who? Those with seizures

You have to monitor what 2 labs in someone taking lithium? creatinine

TSH

First line treatment for PCOS? OCPs and then ovulaiton induction with clomiphene
when they want to become preggors

Main feeding recommendation in those with progressed dementia? Hand feeding

Common pneumonia in the immunocompromised? Jirovecii or pneumocystis

What should always be done prior to surgery on a RA+ patient? Need a cervical
spine X-ray to avoid atlantoaxial subluxation

Only two other common conditions selectively limit passive external rotation what are
they? locked posterior shoulder dislocation and OA

A 52-year-old female with a history of well-controlled diabetes mellitus presents with

right shoulder pain for 2 months. She cannot recall any injury. The pain is fairly
constant, has a burning quality, and disturbs her sleep.

On examination the patient has no redness or swelling. Passive and active abduction
are limited to 45°. There is some limitation of shoulder flexion and internal rotation, but it
is less pronounced. No focal tenderness is found. Plain films are negative.

Which one of the following is the most likely diagnosis for this patient? Frozen
shoulder

Patients with a CD4+ count <200 cells/mm3 should receive for prevention of
Pneumocystis pneumonia, and prophylaxis against bactrim

Prophlyaxis against what should be given if a CD4+ count is below 100? Toxo

Azithromycin is used to prevent infection with ____________________ when CD4+

counts are <50 cells/mm3 MAC

________ results from interruption of the blood supply to the still-growing femoral head
and occurs in children 2-12 with internal rotation pain and hip abduction Legg-Calvé-
Perthes disease

FABER and FADIR tests are specific for what? labral tears

A patient with ankylosing spondylitis who has an injected conjuctiva should be treated
with what? Oral corticosteroids- Likely uveitis (photophobia and slightly sluggish pupil)
First line pharm therapy for PTSD? SSRIs or SNRIs

A single nostril clear rhinorrhea that may be intermittent or continuous could be what?
CSF

If you dorsiflex the foot and elicit pain on the foot and palpation elicits pain what is the
dx? Plantar fascitis

If someone has a penicillin allergy what cephalosporins can we give? cefdinir,

cefuroxime, or cefpodoxime

If someone had a _______________ we would not perform an exercise stress tes

Left bundle branch block

What BB do we not use in pregnancy? atenolol

All pregnant women should get Tdap boosters to protect the newborn against pertussis,
when should they get it? 27-36 weeks

The presence of eosinophiluria in a patient with acute kidney injury (AKI) suggests
what? acute interstitial nephritis

What is the best course of antibiotics for a child under 29 days with suspected sepsis?
ampicillin and cefotaxime

What patients get stress ulcer prophylaxis? Intensive care patients (and those on
vents)

anemia, neurologic changes, fever, and renal failure are seen with what? ITP or TTP?
ITP

What diseases mean you need an increased dose of warfarin? hypothyroidism,

visceral carcinoma, increased vitamin K intake, diabetes mellitus, and hyperlipidemia

Mainstays of treatments for cluster headaches? verapamil or lithium

In terminally ill delirious patients what is the treatment of choice? haloperidol

Treatment of choice for RSV? supplemental O2

is an idiopathic inflammatory disease affecting the skin and oral mucosa. The
characteristic violaceous, polygonal papules may be intensely itchy. Lichen planus,
commonly seen with HCV

The goal A1C for geriatric patients is below what? 8.5

A likelihood ratio of 1 means with? >1? <1? 1-does not change the probability of
disease
>1- the more likely it is that the disease is present
<1- less likely the disease is present

The most common inhibitor discovered during the evaluation of an elevated aPTT is an
what? antiphospholipid syndrome

Opioid used in renal failure fentanyl

Pulmonary function tests are normal except for a low diffusing capacity of the lung for
carbon monoxide (DLCO), what does this indicate Chronic PE --> Interstital lung
disease will show restrictive PFTs

What red flag findings indicate the need for an upper GI scope rather than trial use of an
H2 blocker or PPI? Older age
weight loss
vomiting

If someone has had an ear infection that was recently treated by the normal antibiotics
and then gets one prior to 30 days, what should we treat it with? Treat the first
infection with amoxicillin and then with augmentin 90mg for 10 days

Which one of the following is the best exercise to improve function in older adults living
in nursing homes? resistance training

First line treatment for atopic dermatitis flare up topical corticosteroids

An often unrecognized and untreated side effect of long term opioid abuse?
hypogonadism

Barking like cough indicates what? croup - treat with oral Dexamethasone

A 4-year-old male sees you for pre-kindergarten screening. On corneal light reflex
testing, the light reflex in the patient's right eye is in the center of the pupil. In the left
eye it is located below the pupil, over the inferior-lateral portion of the iris.

This clinical finding is associated with a congenital palsy of which one of the following
cranial nerves? 4th- b/c the eye is drifting laterally and inferiorly so the superior
oblique (medial and superior) (4th nerve) is impaired

Post-tussive emesis is classic for what? whooping cough

BPs in children are based on what? Sex, height, and age

Classic extra-GI sign of Crohn's disease erythema nodosum near the shins
Can you evaluate intermediate risk DVT patients with D-Dimer? No, need US

The most common causes of serious bacterial infection in children 3-36 months of age
are what two things? pneumonia and UTI

Symptomatic treatment for Raynaud's disease? Nifedipine

Before the classic findings develop, patients will have tenderness out of proportion to
the physical appearance of the injury and, most importantly, severe pain in the involved
compartment with passive stretching of the involved muscles. What problem is
occurring here? compartment syndrome

Reduced FVC and an increased FEV1/FVC ratio indicates what? restrictive lung
disease

A 56-year-old male with diabetes mellitus and hypertension presents with a 6-month
history of generalized pruritus. He reports that he scratches frequently. On examination
his skin is dry and scaly. He has multiple linear excoriations and thickened skin on his
forearms, legs, and neck.

Which one of the following is the most likely cause of his pruritus? lichen simplex
chronicus

In patients with H. Pylori who are treated with clarithromycin what BP medication can
we not give them? Can't give norvasc b/c CYP450 interactions

For BCC lesions around the nose, especially those >1 cm, __________ is the preferred
treatment Moh's microsurgery

Best long term treatment for lateral epicondylitis? expectant/conservative

management

Who should we avoid morphine in? CKD patients b/c it forms toxic metabolites

Do we place in dwelling catheters routinely? No, not in someone who is not critically
ill

In a person with adrenal insufficiency we commonly see electrolyte imbalances and low
BP, what do we give? IV hydrocortisone to replace the lost cortisol

Imaging modality needed for OM? MRI

What is the target uric acid level in patients with gout? 5-6mg/dl

Recommended lab to monitor for microcytic anemia? ferritin

Long QT interval is associated with what? polymorphic ventricular tachycardia

Treatment for psoriasis plaques? Clobetasol 0.05% cream (Temovate) applied twice
daily

After COPD exacerbation what do we give for oral home meds? 5 days of oral
prednisone

What antibiotic can we prescribe for rosecea? doxycycline

What can we apply to a fresh surgical excision? petroleum jelly (no ABs)

A reduction of the pain caused by abdominal palpation when the abdominal muscles are
tightened is known as _________ sign and may indicate an abdominal hematoma
Carnett's sign

An acute rectal fissure is treated how most conservatively? With nitroglycerin to relax
the sphincter topically

What value does clorthalidone have over HCT? longer half life

What diuretic should we use in patient's with treatment resistant HTN?

spirinolactone

What defines delirium tremens from other forms of withdrawal? Fever

First line opioid for chronic pain? morphine

How does diastolic heart failure normally present? elderly

preserved EF
LVH

Erysipelas is caused primarily by what agent? Group A strep

In alcoholic liver disease what LFTs do we normally find? An AST/ALT ratio >2
AST over ALT (S for shitty liver)

If you suspect septic arthritis what should you do? order a US for aspiration

What asymptomatic patient should have a prophylactic cholesyetcomy? SSA patients

A common diuretic that can cause SLE? Hydralazine

A positive Thessaly test indicates what? Medial meniscal tear

There is a strong association between dupytrens and what? Diabetes

What part of medicare is hospital benefits? Part A

If someone has pain when they bend their legs and you press on their abdomen
(Carnett's sign) what is the likely pathology? Likely due to an issue with the
abdominal wall itself.

If you suspect someone to have a parathyroid problem but find their 24 hour urine
calcium to be low, what do you suspect? familial hypocalciuric hypercalcemia

What type of stools are formed in C. Diff? semi-formed

Why are NSAIDs CIed for pain control in angina? May weaken myocardial muscles

A 25-year-old female has an annular rash on the dorsal surface of both hands. The rash
does not respond to initial treatment with an antifungal medication, and a biopsy reveals
granuloma annulare.
Which one of the following would be the most appropriate advice for this patient? allow
the rash to resolve doesn't need to be treated

Nursemaid's elbow occurs when what happens? radial subluxation

When do we screen for gestational diabetes 24-28 weeks

Normal EF range? 55-75%

A 44-year-old male in the intensive-care unit develops acute respiratory distress

syndrome (ARDS). Which one of the following has been shown to improve outcomes in
this situation?` lower tidal volumes

Firs line treatment against peripheral neuropathy TCAs

All children diagnosed with DMI should be screened for what? Hypothyroidism

Treatment for later TB in an HIV patient? isoniazid (rifampin will interact with
retrovirals)

Describe neurogenic bladder?

How do we treat it? Leaking large amounts of urine constantly
Treat with a strict voiding schedule

Treatment for cocaine associated chest pain? Ativan IV

Vesicles located on the upper eyelid indicate what? What should be done? herpes
zoster ophthalmicus
treat with anti-retrovirals and then refer to ophtho

Niacin can be toxic to what? Liver

The most common cause of hypoglycemia in a previously stable, well-controlled

diabetic patient who has not changed his or her diet or insulin dosage is what?
diabetic renal disease

What imaging modality is important for someone with acute chest pain? PA and
lateral chest films

A 2 year old boy who is developing normally but is slow to walk should have what lab
drawn? creatine kinase --> check for DMD

Children from 2 to 6 often feel what about the loss of a love one? they are
responsible

Test used to determine if you have eradicated H. pylori after treatment? urea breath
test

What hepatitis vaccine should all diabetic patients receive? Hepatitis B

What risk factors make surgical management necessary for a clavicular fx?
Midshaft
comminuted
female
older age
displaced

Define postpartum urinary retention. treatment? post-void bladder residual of at

least 150 cc that is present 6 hours or more after delivery.

treatment- discharge with a catheter in place and close F/U

What is the upper most limit of the dosage of morphine you can use? No limit

Dosage of amoxicillin in child with acute otitis media? 80-90 mg/kg/day.

So 17kg kid is roughy 1300-1500 mg

What are some issues that Sympathomimetic decongestants can cause? elevate blood
pressure and intraocular pressure, may worsen existing urinary obstruction

physical exam finding in a complete quadriceps tear the patient has no ability to
straighten the leg
Sulcus sign above patella (indentation as the patella is pulled upwards)
A localized inflammatory lesion of the skin, usually found
in the extremities following exposure to nonfreezing cold temperatures Pernio, or
chilblains

Herbal remedy for anxiety Kava

Supplements that when deficient may affect smell vitamins A, B6, B12, and trace
metals

autosomal dominant disease characterized by indirect hyperbilirubinemia caused by

impaired glucuronyl transferase activity. Gilbert syndrome

Treatments for impetigo topical muciporin

cephalexin or amoxicillin/clavulanate

Preferred pressor agents for septic hypotension? Dopamine and norepinephrine

Normal parathyroid levels in a patient with hypercalcemia indicate what?

Hyperparathryoidism

Recommended HBG level in someone with CKD? 10-12 higher levels increase the
risk of heart disease and MI

valvular pathology seen in Marfans Aortic insufficiency

To be tertiary prevention someone must have what? must have diagnosed disease

characterized by depressed mood for at least 2 years in addition to at least two of the
following: change in appetite, alteration in sleep, low energy, low self-esteem, poor
concentration, or feelings of hopelessness Dysthymic disorder

Men who take testosterone need an H/H routinely, why? Can make them
polycythemic

What type of environment makes iron more easily absorbed? acidic gastric environment

You are evaluating a 25-year-old gravida 5 para 1 at 6 weeks estimated gestation. She
has a history of three consecutive spontaneous miscarriages. Her workup has been
negative except for a positive lupus anticoagulant on two occasions, separated by 6
weeks. You make the diagnosis of antiphospholipid antibody syndrome. She has no
previous history of venous or arterial thrombosis. The best medical management at this
time is: aspirin and heparin
APHLS want to prevent an embolism from forming
Dizziness associated with what is a severe problem that needs further workup?
diplopia

Most common agent to co-infect someone with influenza to cause pneumonia? MRSA

Two first line agents to treat HTN in someone with stable coronary artery disease?
BB
ACE (NOT AN ARB)

only _____________ and ____________ are indicated for treating bipolar depression or
acute mania, and for maintenance divalproex and lithium

In a diabetic patient with coronary artery disease what intervention is best?

Treatment with CABG has best success rates

Acute onset abdominal pain in a young child with billows emesis Malrotation and
volvulus

Three antibiotics used to treat C. Diff Metronidazole, vancomycin, and fidaxomicin

The timed get up and go test should be done in how many seconds? 10

If someone has acute onset hyponatremia (less than 48 hours) what do we do?
Hypertonic saline infusion

Parvovirus B19 is associated with erythema ___________ of fifth's diseae infectiousum

Multiforme- HSV and mycoplasma j

marginatum- rheumatic fever
migrans- lyme

Most effective form of family planning? cervical mucus monitoring

You have to give vanc ________ and metronidazole ________ in patients with C. diff
orally
IV

In a patient with a seizure disorder who wants an IUD what are the two options? A
levonorgestrel intrauterine device (Mirena)
Copper IUD

Don't want excess estrogen b/c can have side effects

If someone is on dual platelet therapy with clopidogril and ASA which do we need to
stop 5 days prior to CABG? ASA, clop, or both? Stop Clop only, keep ASA on
Why do hyperglycemic patients have a lower sodium level? They appear lower, but
actually what occurs is they get wash out as the excess glucose in the extracellular
space (can't be stored in the cells so moves to extracellular space) pulls water into the
extracellular space --> leads to dilution of serum and electrolytes

Earliest age we can prescribe a stimulant preschoolers

Do we routinely screen high risk patients with carotid US? No, only if they are
symptomatic

People taking carbamazepine have a five-to eightfold increased risk of developing

what? agranulocytosis- think of guy with mask holding up hourlgass

Contrary to popular belief static stretching is what? useless if not detrimental to

athlete performance

______________ is an ocular misalignment that can be diagnosed on a cover/uncover

test when the corneal light reflex is deviated from its normal position slightly nasal to
mid-pupil. strabismus

____________ is cortical visual impairment from abnormal eye development-most often

as a result of strabismus amblyopia

___________ is a type of strabismus with an inward or nasal deviation of the eye that
would be evidenced by a corneal light reflex lateral to its normal position Esotropia

amylase or lipase is less likely to be elevated in alcoholics? amylase is less likely to be

elevated in alcoholics

____________, which is to purposefully feign physical symptoms for external gain

malingering

One day after a nurse performs CPR on an emergency-department patient, she learns
that the patient had meningococcal meningitis. Which one of the following is the most
appropriate chemoprophylaxis for this condition? Rifampin 600mg BID for 2 days

**Remember in sketchy the police officer with rifampin rifles

A 3-year-old male was treated for acute otitis media last month. His mother brings him
in for follow-up because she believes his hearing has not been normal since then. He
attends day care and has had several upper respiratory infections. On examination the
tympanic membranes are not inflamed, but the membrane is retracted on the right side.
An office tympanogram shows a normal peak (type A) on the left side, but a flat tracing
(type B) on the right side. Which one of the following would be the most appropriate
recommendation? Observation with follow up b/c he is unlikely to lose development of
speech with one ear --> he has serous otitis media, observe and if no better in 3 months
may need tubes in his ears

Difference between anemia of chronic disease and iron deficiency anemia? AoCD:
reduction in iron, transferrin, and transferrin saturation, normal ferritin or increased

IDA: low iron levels, increased transferrin levels, and reduced ferritin levels.

Urgent test ordered in cauda equina? MRI

____________ is not characteristic of patellofemoral pain syndrome, so a loose body or

meniscal tear should be considered if this is reported. locking

Chlordiazepoxide is a preferred benzo in alcohol withdrawal, why? long lasting benzo

If a woman has an HPV+ test, but not serotypes 16 and 18 what do we do? repeat
testing in 1 year

reatment of external genital and perianal warts in patients 12 years of age and over is
done with what drug? Imiquimod (Aldara)

Best option for constipation when using opioids? Miralax (polyethylene glycol)

Wheezing in a newborn that is feeding is most likely associated with what? GERD

Wheezing with ___________ in a newborn is position related tracheomalacia

What activities are usually the first to go in dementia? instrumental tasks of daily living
such as managing money and medications, shopping, cooking, housekeeping, and
transportation

Main indication for a knee replacement? severe joint pain

Herald patches are common in what? pityriasis rosea

What neurological hemorrhage is the first step always surgery consultation?

cerebellar hemorrhage

Above what BNP level is HF? BNP >100

In a woman with AUB who does not want a hysterectomy and is not exhibiting atypia,
what can we do? Give progesterone therapy

A newborn who appears with signs of varicella what should we do IV immunoglobulin

IV acyclovir
If mom had it but its been 7 days since the lesions crusted don't worry just observe

Antibiotic of choice for traveler's diarrhea? ciprofloxacin

Depression pharm therapy in a patient with only weeks to live? methylphenidate-

stimulants work faster

New onset facial nerve weakness should be treated with what first if it is not an ischemic
cause? Corticosteroid therapy

In a patient with suspected Marfans what imaging test should you order? echo

An 80-year-old male nonsmoker with Parkinson's disease is treated for community-

acquired pneumonia with azithromycin (Zithromax), 500 mg/day for 10 days. On follow-
up the patient feels better but still has a productive cough. A repeat chest radiograph
reveals a single thin-walled cavity lesion in the left lower lobe.

It would be most appropriate to replace this patient's azithromycin with? Clindamycin

(anaerobic infection)

Who is responsible for alerting a patient about mammogram results? The facility
the test occurs in

Evidence of _______________ dysfunction is evidence of heatstroke rather than heat

exhaustion, CNS

A low risk patient with a ruptured peptic ulcer can do what the same day as their
endoscopy? Be sent home on oral PPI if stable

First two imaging modalities used to diagnose stress fracture X-ray

MRI

Best indicator of a patient becoming hypoglycemic? (not symptoms but what indicates
from a hx or meds they will likely become hypoglycemic) Previous episode of
hypoglycemia

In a patient with finger pain who can't fully extend the finger and has a confirmed
fracture of the DIP joint, what should we do? splint in full extension for 8 weeks

Both stress and urger incontinence are best treated how at first? CBT and bladder
training

What possible viral etiology/illness must be treated with immediate antibiotics to reduce
risk of airway compromise? epiglottis (H. Flu type B)
__________ is appropriate for intrapartum prophylaxis against group B Streptococcus
(GBS) in penicillin-allergic patients who do not have a history of anaphylaxis, urticaria,
angioedema, or respiratory distress. cefazolin

Treatment for when with hypoactive sexual desire disorder? topical testosterone

The appropriate management of a thrombosed hemorrhoid presenting within 72 hours

of the onset of symptoms is what? elliptical excision of the hemorrhoid and
overlying skin under local anesthesia,

Which hemorrhoids have no pain? How do we treat them? internal- banding them

What is a Jarisch-Herxheimer reaction an acute, transient, febrile reaction that occurs

within the first few hours after treatment for syphilis.

What age do we screen asymptomatic patients for diabetes? 45

Common side effect of aromatase inhibitors such as letrozole myalgias

Myelodyplastic syndrome commonly occurs with what three blood based issues?
macrocytic anemia
decreased WBC
Decreased platelets

For the next few say what type of asthmatic they are

Symptoms less than or equal to twice weekly, nighttime awakenings ≤2 times/month

intermittent

a medical emergency and requires emergent treatment in a hospital setting. status

asthmaticus

Daily symptoms, nighttime awakenings greater than once weekly but not nightly,
FEV1/FVC reduced by 5% moderate persistent

Symptoms >2 days/week but not daily, nighttime awakenings 3-4 times/month, mild
persistent

Symptoms throughout the day, nighttime awakenings nightly, short-acting β-agonist

usage several times daily, extremely limited daily activities, Severe persistent

Treatment of choice in a vertebral fracture? calcitonin to help reduce pain and

prevent further fractures

Painful vesicles in the mouth and ear, what is the causative agent? Varicella zoster
virus
Extracorporeal shock wave therapy is effective for ____________ of the rotator cuff
calcific tendinitis

The maximum heart rate during exercise does what as we age? decreases

What drug can we not give to someone in heart failure b/c it of its negative ionotropic
effects verapamil

ncreases in subareolar fat secondary to his obesity pseudogynecomastia

Skip lesions throughout the small and large bowel indicate what? crohns disease
(prednisone)

Osteoporosis is most common in what ethnicity? whites

Corynebacterium minutissimum, a condition known as erythrasma, is best treated with

what? Erythromycin

USPSTF recommends US for abdominal aortic anuerysm in what population of people?

men 65-75 who have ever smoked

For patients undergoing major orthopedic surgery, the American College of Chest
Physicians recommends outpatient thromboprophylaxis for a duration of up to ______
days 35

__________ is a newer synthetic agent in the therapeutic class of phosphate binders,

which includes calcium acetate. This works by binding phosphate to increase calcium
levels by reducing parathyroid hormone secretion sevelamer

_______ is the treatment of choice for childhood OSA tonsillectomy/adenoidectomy

You acidify the urine pH if you have what type of kidney stone? calcium phosphate

First line treatment of comedones in acne? topical isoretinoid

definitive treatment for SCFE? surgery (patient can't bear weight, no trauma, no
elevated wBC or fever, non-specific symptoms 11-13 y/o)

First two things to give in hyperkalemia? albuterol will rapidly lower it and calcium
gluconate to stabilize the cardiac membranes

If a patient presents with normal nighttime labs, but then profoundly different in the
morning what are three possibilities? medications caused this
infection/disease
blood drawn from the wrong place
Drug of choice for peripheral claudication? cilostazol

A neutrophil count above what is diagnostic for peritonitis? 250

What heart arrhythmia is most common in anorexic nervosa patients? sinus brady
cardia

If someone tests positive for gonorrhea on PCR what do we give them? 250mg IM
ceftriaxone and 1g azithromycin orally

-Different than a previous answer but always treat both even with a highly specific and
sensitive test saying chlamydia is negative

Regional anesthesia during delivery will increase what? the risk of instrument
assisted vaginal delivery

Women with migraines are contraindicated from dying what? combined oral
contraceptives

two main risk factors for macular degeneration? HTN and smoking

What is the worse pathology report of a pap smear? Atypical glandular cells not
otherwise specified (AGC-NOS)

There is a 5% likelihood of the results having occurred by chance alone defines what
parameter? the p-value

pediatric patients cannot have food ___ hours prior to surgery or clear liquids ____
hours prior to surgery 8
2

typically follows an upper respiratory tract infection, and presents with low-grade fever,
fatigue, arthralgia, and colicky abdominal pain. The hallmark of the disease is the rash,
which begins as pink maculopapules, progresses to petechiae or purpura, which are
clinically palpable, and changes in color from red to dusty brown before fading
Henoch-schonlein purpura

Limited internal rotation of the flexed hip in a young male may indicate what? SCFE

Difference between Multiple myeloma

and Waldenström's macroglobulinemia? MM- BJ proteins and IgM spike with bone
lesions (lytic bone lesions)

Waldenstrom- BJ proteins and IgM spike but no bone lesions are seen
Undetermined significance one you don't get BJ proteins

Persistent groin pain in a runner with limited hip flexion stress fracture of the right
femoral neck

A 4-year-old female has had three urinary tract infections in the past 6 months. She
complains of difficulty with urination and on examination is noted to have labial
adhesions that have resulted in near closing of the introitus. Which one of the following
is the most appropriate management? topical estrogen twice a day

Wandering and pacing in AD is amenable to what drug therapy No drugs (insomnia

you can use ativan)

Drug that reduces hip and vertebral fractures zoledronic acid

What environment is iron best absorbed in? acidic (give ascorbic acid)

First line treatment of PTSD? SSRI

Int eh general population the most common cause of seizures are what Stroke

What is the first line treatment for bed wetting? Nocturnal clock for urinating

Main treatment for a dehydrated child? An over-the-counter oral rehydration solution

Treatment to decrease rinhorrhea in the common cold? ipratropium

Sever complication of pyloric stenosis profound hypochloremic metabolic alkalosis

A PPD testing may be a false NEGATIVE if administered 2-30 days after what? MMR
vaccine

What two common antibiotics interact with statins? clarithromycin or erythromycin

__________ causes an intense urge to void, which overcomes the patient's voluntary
attempt to hold the sphincter closed (urge incontinence mechanism) Detrusor
instability

Most important indicator of DKA severity bicarb level

___________ in children manifests as brown or cola-colored urine, which may be

painless or associated with mild flank or abdominal pain. acute glomerulonephritis-
look for RBCs in urine

RCT and _________ are the gold standards for guidelines of care meta analysis
For breastfed newborns who have an early onset of hyperbilirubinemia, the frequency of
feeding should be increased to more than _______- times per day. 10

What fluorquinolone is not used to treat UTIs? Moxifloxacin- does not penetrate
adequately

What test is best to confirm a kidney stone? helical non contrast CT

Wheezing and profuse rhinorrhea are characteristic and the disease typically occurs in
mid-winter or early spring epidemics RSV

MOA of metformin? Inhibits glucose production by the liver

If someone has had a hysterectomy and it was for confirmed benign disease, how often
should they get a pap smear? Don't need one anymore

Most common cause of proteinuria in children? orthostatic protenuria

What will you not see in PCOS that you will see in Cushing's? easy bruising

Imaging of choice to look for osteomyelitis MRI

NNT equation? 1/ARR

ARR=Incidence X reduction risk (so if incidence is 1% and you reduce the risk by 50%,
0.5X0.01)
1/0.005=200

Best treatment for head lice? malathion

__________ can significantly worsen renal failure in patients with hypertension caused
by renovascular disease ace inhibitors

Most common stress fracture? tibia

How soon after bacterial conjuctivitis treatment is initially started can a child return to
school? same day

Most common nutritional deficiency in the USA? iron

In a small child what is the best initial treatment of any microcytic anemia? trial of iron