Flashcards in AAFP Review Questions Deck (466)
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61
First-line therapy for nausea and vomiting of pregnancy
Vitamin B6
Scopolamine is effective for nausea and vomiting of pregnancy but should be avoided in the first trimester
due to the possibility of causing trunk and limb deformities. Likewise, methylprednisolone is also effective
but should be avoided in the first trimester as it is associated with an increased risk of cleft palate if used
before 10 weeks of gestation.
62
Who should get antibiotics before dental work?
According to the American Heart Association’s 2007 guidelines, prophylaxis to prevent bacterial
endocarditis associated with dental, gastrointestinal, or genitourinary procedures is now indicated only for
high-risk patients with prosthetic valves, a previous history of endocarditis, unrepaired cyanotic congenital
heart disease (CHD), or CHD repaired with prosthetic material, and for cardiac transplant recipients who
develop valvular disease.
Based on a risk-benefit analysis in light of available evidence for and against antibiotic prophylaxis, these
recommendations specifically exclude mitral valve prolapse and acquired valvular disease, even if they are
associated with mitral regurgitation. The American Dental Association has endorsed this guideline.
63
Side effect of methimazole
AGRANULOCYTOSIS
Other rare complications of methimazole include serum sickness, cholestatic
jaundice, alopecia, nephrotic syndrome, hypoglycemia, and loss of taste. It is associated with an increased
risk of fetal anomalies, so propylthiouracil (PTU) is preferred in pregnancy.
64
Target LDL for diabetes
<100 (but lower is better, so <70 ideally!)
Patients with DM are considered to have known CAD, so 100 is target.
65
Apart from diabetic medications, what should all DM patients be on?
ACE-inhibitor or ARB for cardiovascular and renal protection
Microalbuminuria is a RF for CVD and progression of renal disease to ESRD and dialysis. ACE-Is/ARBs have been shown to decrease risk EVEN IN NORMOTENSIVE PATIENTS
66
If new-onset migraine with nuchal rigidity, think...
SUBARACHNOID HEMORRHAGE
Get LP
(If there was a similar headache a few weeks before, think SENTINEL BLEED from an aneurysm)
67
3-6 week old infant with projectile vomiting, visible peristaltic wave, and olive-like mass
PYLORIC STENOSIS
Hypochloremic, hypokalemic metabolic alkalosis
68
Acid-base status in pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
69
Best breast screening for concerning mass in:
<35
>35
<35: Ultrasound (since breast tissue is too dense for mammogram)
>35: Mammography
70
Treatment of enterobiasis (pinworm)
Albendazole or mebendazole in ALL HOUSEHOLD MEMBERS
(pyrantel pamoate if pregnant since azoles are teratogenic)
Also wash clothes and bedding, and trim nails (since under nails is most common place for eggs to hide out)
71
What things are needed to evaluate acute coronary syndrome?
EKG and serial troponins
(Unstable angina, NSTEMI, STEMI)
72
Treatment of vulvar candidiasis
Single dose of oral fluconazole or several days of miconazole or clotrimazole vaginal creams
73
Presentation of vulvar candidiasis
-vulvar pruritis [dominant sx]
-discharge: white with curd-like consistency ("cottage cheese")
-low vaginal pH (<4.5)
-KOH: budding yeast and hyphae
Other symptoms could include:
-dysuria
-vulvovaginal irritation
-dyspareunia
74
Alport syndrome
Glomerular hematuria along sensorineural deafness and ocular abnormalities (can't see, can't pee, can't hear). Since this is an inherited disease, there should also be a family history of renal failure and deafness. The primary defect is a genetic mutation in collagen type IV.
75
Immediate treatment of hyperkalemia
IV calcium gluconate
(even if very high and need dialysis, start with IV calcium as a temporizing measure to stabilize the myocardium)
76
Hyperkalemia on EKG
Peaked T waves
Medical emergency: IV calcium to stabilize myocardium
77
If HTN <30 y.o., think...
secondary HTN (as opposed to essential HTN), such as fibromuscular dysplasia
78
Drugs for uterine atony
-Carboprost (Hemabate) [contraindicated in asthma]
-Methylergonovine [contraindicated in HTN]
-Misoprostol (Cytotec)
-Oxytocin (Pitocin)
79
Treatment of acute parotitis
Amoxicillin/clavulanate (Augmentin)
Staphylococcus most common pathogen
80
Fever in child under 29 days old
Any child younger than 29 days old with a fever and any child who appears toxic, regardless of age,
should undergo a complete sepsis workup and be admitted to the hospital for observation until culture
results are known or the source of the fever is found and treated
81
Ottawa ankle rules
X-ray only needed if one or more of the following are positive:
1. Tenderness of the distal 6 cm POSTERIOR edge of tibia (medial malleolus)
2. Tenderness of the distal 6 cm POSTERIOR edge of fibula (lateral malleolus)
3. Tenderness of the navicular
4. Tenderness of the proximal 5th metatarsal
5. Inability to bear weight for four steps immediately after the injury or at examination
82
Finklestein test
De Quervain tenosynovitis
Place thumb in palm, close fingers around it; maximally deviate in ulnar direction.
+ is pain when maximally ulnar deviated
83
Phalen test
Carpal tunnel syndrome
Dorsum of hands together with wrists in forced flexion for 30-60 sec
+ is numbness of palmar thumb, index finger, and middle finger
84
Tinel test
Carpal tunnel syndrome
Lightly tap median nerve at palmar wrist
+ is electric jolt down middle finger
85
Spurling maneuver
Cervical nerve root pain
Turn head toward affected side with neck extended; exert downward pressure
+ is pain, numbness, weakness down arm
86
Speed's test
Tendinitis of long head of the biceps
Arm supinated, elbow extended, resist forward flexion at shoulder
+ is pain in biceps groove
87
Empty can test
Supaspinatus tendon
Arms extended at 30 degrees, thumbs pointing down, resist upward motion
+ is weakness or pain
88
Drop arm test
Supraspinatus tendon tear
Passively hold arm extended at shoulder level and release; allow patient to slowly lower arm to waist
+ is instability to control maneuver to waist
89
Lift off test
Subscapularis
Dorsum of hands in lumbar area, resist straight lift off
+ is pain or weakness
90
