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BL inservice exam Flashcards

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1
Q

How would you confirm Legionnaires disease?

A

Urine testing for Legionella pneumophila antigen

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2
Q

During pregnancy, what increases the risk of hip dysplasia in the infant?

A

Breech Presentation

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3
Q

If a parent refuses to vaccinate their kid, what does the CDC recommend you do?

A

Have the parents sign a refusal to vaccinate form

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4
Q

Carpet layer has swelling of the R knee proximal to the patella. No systemic syx. Knee is swollen but minimally tender. How do you manage?

A

RICE

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5
Q

What is a pt’s history (HTN, CHF, TIA, PUD, ischemic stroke, T2DM) is an absolute contradiction to fibrinolytic therapy

A

Ischemic stroke

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6
Q

57 F with sudden onset L hearing loss. Weber materializes to R side. Rinne is heard better on the L. You refer to ENT, but what else do you need to start?

A

Prednisone

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7
Q

High school kid inverts foot during a game. Pain is across the mid foot and edema over lateral malleolus and diffuse tenderness. No pain of the navicular, base of 5th metatarsal, posterior distal lateral or medial malleoli. How do you manage?

A

Lace up ankle support, ice, compression, and clinical follow-up

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8
Q

Pt has SOB, responsive to steroids and albuterol, chronic cough, blurry vision. CXR with pan lobular basal emphysema. FEV1/FVC < 0.7, not reversible with inhaler. Dx?

A

alpha1-antitrypsin deficiency

Other options: ILD, bronchiectasis, and diffuse panbronchilitis cause cough but do not cause FEV1/FVC changes.

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9
Q

CXR finding in bronchiectasis

A

Bronchial dilation and bronchial wall thickening

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10
Q

CXR findings in ILD

A

Reticular or increased interstitial markings

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11
Q

CXR findings in diffuse panbronchiolitis

A

Diffuse small centrilobular nodular opacities along with hyperinflation

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12
Q

Male has low testosterone c/w hypogonadism, what workup would you recommend next?

A

Check FSH/LH
Helps distinguish between primary and secondary hypogonadism
Low/normal FSH/LH suggest secondary
If primary - karyotype for klinefelters
If secondary - check prolactin, Iron, TIBC. May consider MRI

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13
Q

Tx for constipation in 4 y/o

A

PEG
More effective than lactulose, Senna, Mag hydroxide
No evidence to support fiber

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14
Q

IVDU with fever but all other vitals ok. What is important?

A

Blood cultures - high risk for bacterial endocarditis even if not septic.

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15
Q

Newborn exam, front half of foot turns inward and with gentle pressure your are able to straighten the foot into normal alignment. Now what?

A

Observation
Dx - flexible metatarsus adducts, most common congenital foot deformity
Usually spontaneously resolves by 1 y/o
If you were unable to straighten on exam (ie rigid metatarsus) pt would require serial casting

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16
Q

35 y/o F with tremor. Jerking movement in one hand, then the other. Syx resolve when she is distracted. NL Neuro exam. Dx?

A

Psychogenic tremor

Characterized by abrupt onset, spontaneous remission, resolves with distraction

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17
Q

Symmetric fine tremor involving wrist, hands, head, lower extremities

A

essential tremor

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18
Q

Patient with dementia has been on Seroquel for 6 months and doing well on it. Taper or no?

A

Patients who have been on antipsychotics for >3 months and doing should undergo a slow taper (d/t risk of AE’s; increased mortality, falls, CVA, EPS symptoms). Reduce by 25% every 2 weeks

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19
Q

Young health care working traveling to TB endemic area. What is your rec?

A

PPD or quantiferon before travel
If negative, repeat testing 8-10 weeks after return
Don’t need PPx treatment

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20
Q

Young pt with fatigue, hair loss, weight gain. TSH elevated, T4 low, TPO elevated. Thyroid not palpable. Dx and Tx?

A

Hashimoto thyroiditis

Start levothyroxine and recheck TSH in 6-8 weeks.

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21
Q

Primary RF for successful suicide in men?

A

Access to firearms or other lethal weapon

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22
Q

Patient has Type II AV block on EKG (in setting of known sarcoidosis). What does he need?

A

Evaluation for pacemaker

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23
Q

Pt couldn’t tolerate 40mg Lipitor. Now what?

A

Can do a trial of moderate intensity statin. Ezetimibe + statin has been shown to be helpful

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24
Q

Patient has dupuytren’s contracture (trigger finger + palmar nodule). Tx?

A

Surgical release if the contracture is over 30 degrees

If less than 30 can do steroid inj

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25
Patient is about to travel and worrying about travelers diarrhea. What med would you recommend
Short course of Azithromycin if she develops diarrhea Can help shorten duration of syx No real ppx tx
26
Criteria in CURB-65
``` Confusion/AMS Uremia (BUN >20) Respiratory rate >30 Hypotension Age > 65 ```
27
Elderly patient has lost interest in his usual activities. What do you do next?
PHQ-9
28
USPTF recommendation to prevent fall in folks >65?
Regular participation in an exercise program
29
Pityriasis rosea is a generally benign disease except for in?
Pregnancy | Increased risk of SAB in 1st trimester
30
50ish y/o M with 1 month of pain in hands and elbows. Swelling of wrist, MCP, and PIP joints. Xray with diffuse bony erosions of MCP and PIP joints. DX?
Rheumatoid arthritis
31
9 y/o with close contact to TB positive person has a PPD with 8mm induration, NL CXR. Now what?
>5mm induration = positive test for those in close contact w/ someone with TB, + CXR or HIV/immunosuppressed NL CXR --> latent TB Kids 2-11 --> isoniazid qd x 9 months adults --> isoniazid x 6 mo, rifampin
32
should a shellfish allergy discourage you from getting IV contrast?
No. no premedication is needed
33
Patient has shoulder weakness when shoulder is adducted and elbow bent to 90 and cannot keep her hand lifted behind her back. Injury in which tendon?
Subscapularis | causes weakness in internal rotation
34
What supplement helps improve quality of life in tinnitus?
Cognitive Behavioral Therapy | Helps to reduce awareness of tinnitus
35
28 y/o F PCOS goal is to avoid menorrhagia. Best initial tx?
``` IUD best 1st line in a patient not interested in fertility Metformin - treats IR Dietary modification - treats obesity spironolactone - hirtuism, acne clomiphene - induce fertility ```
36
6 m/o with rhinorrhea and wheezing but other vitals WNL. Tx?
supportive care | viral bronchiolitis
37
IN asymptomatic sarcoid patients, what extra pulmonary organ should be examined yearly?
Eye Eye inflammation can cause permanent impairment in otherwise asymptomatic patients Skin - usually obvious, not dangerous heart - typically only problematic in symptomatic sarcoid
38
Work up for syncope should include
Orthostatics and EKG
39
60ish guy on routine labs with normocytic anemia, next step?
Get iron studies | If IDA should get C-scope
40
Heel pain, nodular appearance at insertion site of Achilles. Management?
PT and eccentric calf strengthening exercises | Dx - Achilles Tendinopathy
41
F patient with libido issues on Zoloft, what do you do?
Switch to bupropion
42
Patient with chronic redness, flaking, discomfort of eyelids and eyes feel dry/sandpapery at times. Tx?
Warm compress and mild shampoo Dx - blepharitis, chronic inflammation of eye lids Caused by seborrhea or staph Can do abs if resistant
43
T2DM patient asks you about nonnutitive sweetners. What's your rec?
Nonnutritive sweetners are acceptable | should be used in moderation
44
30ish healthy female rhinorrhea, loss of sense of smell x 4 months. On exam swollen nasal turbinates and mucopurulen discharge, dx?
Chronic rhino sinusitis | Presence of at least 2 of: nasal drainage, nasal obstruction, facial pain/pressure, hyposmia/anosmia
45
Pt with metastatic cancer has new back pain x hours worse with laying down. What does she need?
An urgent MRI suspicious for epidural spinal cord compression can be an oncologic emergency Most commonly associated with breast cancer If confirmed need urgent steroids and NSGRY intervention to preserve motor/sensory function
46
Most appropriate initial test to dx pHTN?
Echo
47
Runner has knee pain x 1 week without acute injury. Normal gait. TTP/swelling 1 cm distal to medial joint line. Dx?
Pes anserine bursitis | Medial knee pain 2/2 overuse
48
Vaginitis with malodorous greenish-yellow froth discharge w/ inflammation of cervix and vagina, dx?
Trich
49
Long term risk of Mumps?
Orchitis that can cause decreased fertility Prodrome: myalgia, fatigue, loss of appetite, fever, headache syx: parotitis Complications: Infertility, meningitis, encephalitis
50
Prodrome of cough, coryza, conjunctivitis, Koplik spots
Measles
51
Childhood dz with fluid filled blisters
Varicella
52
Which DM medication increase risk of recurrent yeast infections?
SGLT2 inhibitors | like Jardiance
53
PReggo @ 34wks has diffuse itching and excoriations. Next step?
Get LFTs and Sr Bile levels Get worried about cholestasis of pregnancy anytime a preggo has itching Associated with fetal mortality and can be indication for late pre term induction
54
At which MME should you prescribe naloxone?
50 MME
55
ESRD pt has hypocalcemia. Why?
Still secondary hyperPTH, Bone mineral dz | High phos, high PTH, the high PTH can bind up calcium making low, or can promote bone break down making the calcium high
56
TX for Charcot neuropathy
Immobilization 3-4 months
57
At what age should kids be able to point to picture or body parts?
2 years
58
When is allergy testing helpful?
When pt have frequent viral URI syx | NOT drug allergy rxns
59
When are fibrinolytic indicated for STEMI?
If there is an anticipated 2 hour delay before pt can get cath'd
60
At what ages can you offer low dose CT screening for lung cancer?
55-80 30 pyx quit less than 15 years ago
61
7 y/o with BP in 95th percentile needs?
Renal US Renal etiologies are the most common cause of HTN in pre-adolescents w/u for teen is different
62
Tx for non displaced tuberosity avulsion of 5th metatarsal
Compressive dressing w/ weight bearing and ROM exercise as tolerated
63
Tx for minimally displaced (> 0 mm but <3mm) tuberosity avulsion of 5th metatarsal
Walking boot
64
Tx for displaced tuberosity (>3mm) avulsion of 5th metatarsal
Surgery
65
Long term Tx for WPW
Ablation | Not BBlock and ND CCB b/c of risk of converting to Vfib
66
Elderly pt presents after a choking episode. Gradual difficulty with swallowing over last several months. Modified barium swallow shows collection of barium in the throat in a pouch. Dx?
Zenker's diverticulum Most common structural lesion in elderly Caused by stenosis of cricopharynxgeus and increased hypo pharyngeal pressure d/t swallowing that causes diverticulum above criopharyngeus
67
What would be seen on barium swallow for cervical web or Schatzki ring?
Short segment of narrowing w/o diverticula
68
What would be seen on barium swallow for tracheoesophageal fistular?
Barium would be in the trachea
69
What intervention is most beneficial to improve physical function in an elderly patient?
Resistance training | Helps to reduce frailty before introducing aerobic exercise
70
Term for spoon shaped nail
Koilonychia | Associated with multiple systemic dz ( iron deficiency, hypothyroid, SLE)
71
Thick soft tissue proximal to nail bed
Clubbing
72
White discoloration of nail plate
Leukonychia | Normal variant
73
Thick, yell, dystrophic nail
Onychomycosis
74
Oncologic etiology of erythematous, proliferating mass disrupting normal nail morphology
Squamous cell carcinoma
75
Immunotherapy can help with severe allergic rxns to?
Seasonal allergens | Wasp stings
76
Asyx IVDU presents to establish care. What screenings do you order?
``` HIV Hep A Hep B Hep C TB ```
77
Asyx IVDU presents to establish care. What screenings do you order?
``` HIV Hep A Hep B Hep C TB ```
78
Tx for PNA pt admitted from a nursing home?
CTX/Azithro | Treat like a cAP
79
13 y/o F Tanner 3 wants gender affirming tx to become M. Parents supportive. Now what?
Offer gonadotropin releasing hormone analogue treatment | Should only be offered with pt is tanner 2 or 3
80
concerning finding to suggest poor breast feeding on exam
Infants cheeks are dimpled - suggests poor latch signs of good latch - most or all of areola cannot be seen, chin pressed against the breast, everted nipples yellow stools is also a positive sign
81
concerning finding to suggest poor breast feeding on exam
Infants cheeks are dimpled - suggests poor latch signs of good latch - most or all of areola cannot be seen, chin pressed against the breast, everted nipples yellow stools is also a positive sign
82
Most common infection in a IVDU
Cellulitis
83
Thumb pain after a fall Pain at medial MCP joint mild laxity in her ulnar collateral ligament with 30 degree of joint opening with abduction stress to distal them while stabilizing the metacarpal (vs. 15 degrees on R). Tx?
Thumb spica x 6 weeks Dx - Ulnar collateral Ligament disruption "skier's thumb" Can lead to joint instability and weak pincer grip if untreated Indications for Surgery - avulsion fx, 35-40 degrees of joint opening, no end point on abduction stress
84
Thumb injury w/ joint instability and tender mass
Stener lesion Entrapment of Ulnar collateral ligament outside of the adductor aponeurosis Needs urgent ortho referral
85
Which lab test is best at assessing thyroid function?
TSH best test to dx hypothyroid and is also Abnormal in hyperthyroid T4 is indicated if TSH abnormal
86
Sexual development disorder associated with increased risk of endometrial CA, Celiac dz, Structural heart defect
Turner syndrome
87
Most common cause of chronic cough in adults
Upper airway cough syndrome (AKA PND syndrome) Tobacco use ASthma ACEI
88
Starting someone on allopurinol and what else do you start for ppx?
Colchicine or NSAIDs Reduce risk of gout attacks during urate lowering therapy Exact length is unclear, but should be at least 8 weeks
89
Pt with HTN has hypercalcemia with NL albumin levels. What med do you consider stopping?
HCTZ | Can also check PTH function
90
Pred dosage for COPD admitted to hospital
40mg QD x 5 days
91
Pattern of hairless in Female with androgenetic alopecia?
Diffuse thinning of hair along vertex, sparing among frontal hairline
92
17 y/o F closed comedones on nose, forehead chin. No cystic lesions or body acne. Tx?
Topical adapalene and benzoyl peroxide considered mild acne d/t being limited to T zone 1st line for any severity of acne = retinoids Adapalene is a retinoid available OTC Benzoyl peroxide reduces concentration of cystic acne w/ no risk of bacterial resistance Combo of retinoid and benzoyl peroxide is superior to mono therapy Avoid TOP abx (Glinda erythro) as mono therapy d/t rate of resistance Little data supports effectiveness of alicyclic acid Tazarotene is effective but should be avoided in reproductive age F Can do OCPs for norethindrone (1st gen progesterone) can worsen acne
93
People living in rural areas fit what demographics?
Tend to be older and poorer
94
Tx for heatstroke
immersion in a ice bath until T<102 | if not available - ice pack, cold IVF, evaporative cooking, immersion of extremities work too
95
Giving a patient a pencil and asking them how it is used is assessing their?
Praxis - ability to carry out intentional motor acts with common objects (hair brush, pencil)
96
Asking pt to draw a clock asses their
executive function
97
Asking a pt to name objects and their function asses?
Gnosia
98
Kiddo with Celiac should have what screening annually?
IgA TTG If it does not decrease after 6 months of diet change, it would suggest that kiddo is still eating gluten and needs additional dietary modification
99
How do you handle post exposure prophylaxis after a measles exposure?
Kids < 12 months should get vaccine within 72 hours of exposure pregnant women who are NI should get IVIG Fully vaccinated folks done need it
100
Most common meds causing hyponatremia
SSRIs | Diuretics
101
pregnancy increases risk of which dental issues?
cavities loose teeth gingivitis periodontitis
102
Tx for pt with acute symptomatic urinary retention?
Foley x 3 days Start alpha blocker while it is in Intermittent cath wouldn't give chance to correct underlying issue
103
What med should be stopped 4-6 weeks before getting a plasma Aldo:renin?
Spironolactone - increases aldosterone | ACEI/ARB - increase renin
104
Tx for delirium in hospice pt
Risperiodone
105
kiddo with one time seizure, self resolved, normal work up incl eeg. Now what?
don't start meds
106
indications to screen for developmental dysplasia of hip
breech in 3rd trimester Fix developmental dysplasia of hip Personal hx of instability Other RF - female, first born, oligohydramnios, LGA
107
Recommendation for fluoride supplementation?
Start supplementation at 6 m/o if the primary water supply is fluoride deficient
108
Kiddo has rheumatic fever. Tx?
NSAIDs (ASA or Naproxen) | NOT Tyl
109
Tx for Takotsubo at discharge?
Diuretic ACEI Beta blocker Until syx and Echo abnormalities resolve
110
which patients struggle with MDI?
Pts > 75 Female Low SES Severity of dz and presence of comorbidities
111
Tx for croup
po dex 0.6mg/kg | Even if pt has mild stridor
112
Tx for syx Lyme
Doxy 100 BID x 7-21 days | Can use a single dose of doxy if patient has a tick but no syx
113
skin nodule that is a pearly papule with telangiectasia?
Nodular basal cell carcinoma Most common skin cancer, risk increases with age Fitz I, II Rare mets
114
Pt from AZ with intermittent fevers, night sweats, dry cough, weight loss, myalgias x 4 weeks. Dx?
Cocciodiomycosis
115
pulmonary fungal infection associated with midwest
Histoplasmosis
116
pulmonary fungal infection in medwest, Atlantic, and southeastern states
Blastomycosis
117
classic lab finding in post strep GN
RBC casts
118
Most useful stat in evaluating effectiveness of a tx?
NNT
119
To help with abx stewardship, CDC recommends all pts admitted on an antibiotic empirically to have to time out to review necessity at?
48h post admission
120
FABER test produces posterior pain
SI joint dysfunction
121
parent asks what could increase a toddlers risk of developing asthma?
Exposure to RSV increases risk | exposure to high microbial environment is protective
122
Pt with sinusitis is allergic to PCN. Tx?
Doxy | Will likely have run to Augmentin

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