board study - intraining

Question 1

During rounds at the nursing home, you are informed that there are two residents on the unit
with laboratory-confirmed influenza. According to CDC guidelines, who should receive
chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms

Answer 1

C

an influenza outbreak is defined as two laboratory-confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis for all
asymptomatic residents of the affected unit. Any resident exhibiting symptoms of influenza should be
treated for influenza and not given chemoprophylaxis dosing.
Facility staff of the
affected unit can be considered for chemoprophylaxis if they have not been vaccinated or if they had a
recent vaccination, but chemoprophylaxis is not recommended for all staff in the entire facility.

Question 2

A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has had
two male sex partners in the last 6 months and uses oral contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical motion
and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows only
WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography

Answer 2

Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered at the time
of diagnosis and not delayed until the results of the nucleic acid amplification testing (NAAT) for
gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or adnexal tenderness that can
range from mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy. Acute
phase indicators such as fever, leukocytosis, or an elevated C-reactive protein level may be helpful but are
neither sensitive nor specific. A positive NAAT is not required for diagnosis and treatment because an
upper tract infection may be present, or the causative agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infection. Pelvic ultrasonography may be used if there is a concern
about other pathology such as a tubo-ovarian abscess

Question 3

A 24-year-old patient wants to start the process of transitioning from female to male. He has
been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria.
Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
5.

Answer 3

E

For a female-to-male transgender patient this is most easily accomplished
with testosterone. When testosterone levels are maintained in the normal genetic male range, gonadotropins
and ovarian hormone production is suppressed, which accomplishes both goals for hormonal treatment
without the need for additional gonadotropin suppression from medications such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of a functioning testicle.
Letrozole is an estrogen receptor antagonist, but it would not increase serum testosterone levels.
Spironolactone has androgen receptor blocking effects and would not accomplish either of the hormone
treatment goals.

Question 4

PAP and HPV at what age?

Answer 4

30

Question 5

Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett’s esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes

Answer 5

D

Acid suppression therapy is associated with an increased risk of community-acquired and health
care–associated pneumonia, which is related to gastric overgrowth by gram-negative bacteria. Long-term
treatment of Barrett’s esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI therapy
does not increase the risk of gout, hypertension, or type 2 diabetes.

Question 6

While inflating the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia
2

Answer 6

B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves that
control them, is present in up to 94% of patients with hypocalcemia. Hypercalcemia is more likely to
present with hyperreflexia.

Question 7

24-year old female presents to your office with a 3-month history of difficulty sleeping. She
says that she struggles to fall asleep and wakes up multiple times at night at least three times a
week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies
awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of
the night trying to fall back asleep. Lately she has been feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to return
in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping
an average of 5½ hours per night.
Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an hour if she wakes up at 3:00 a.m.

Answer 7

D

Reducing time in bed increases
sleep efficiency. In this case, 6 hours of time in bed would improve the patient’s sleep efficiency and a
bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is accomplished by
postponing bedtime rather than getting up earlier. Naps generally do not improve sleep efficiency. While
getting out of bed is recommended after being in bed for 30 minutes without falling asleep, or being awake
for 30 minutes after being asleep, staying up for a prescribed period of time is not recommended.

Question 8

how many weeks do you do abx for face?

Answer 8

try to limit it to 12

Question 9

does vitamin D and calcium prevent falls in older adults

Answer 9

nope

Question 10

NYHA class II vs III

Answer 10

I = no limitations
II = mild sx with normal activities
III = significant limitations in actvitities.  Symptoms with less than normal activities - so if they are still doing normal activities, it is a II. 
IV = rest

Question 11

if thinking stress fracture and xray is normal… what next

Answer 11

MRI, not bone scint

Question 12

For the second episode of an abscess, we typically repeat I&D and Word catheter placement.

●For patients who have failed treatment with a Word catheter and now have a third episode, we suggest marsupialization.

Answer 12

.

Question 13

19. Which one of the following should NOT be consumed during pregnancy due to a potentially high
mercury content?
A) Catfish
B) Crawfish, shrimp, and lobster
C) Flounder and haddock
D) Salmon and trout
E) Shark and swordfish

Answer 13

E

- think large fish that consume other fish.

Question 14

migraine in pregnancy 32 weeks.  Failed apap . 
A) Dihydroergotamine
B) Metoclopramide (Reglan)
C) Naproxen
D) Oxycodone (OxyContin)
E) Sumatriptan (Imitrex)

Answer 14

B
Metoclopramide and acetaminophen are the only two medications considered safe for abortive migraine
treatment during pregnancy (SOR B). The dopamine antagonist antiemetics are considered second-line
abortive treatments in the general population. NSAIDs are
not considered safe during pregnancy, particularly in the first and third trimesters. Opioids are only
moderately useful for migraine treatment and should be avoided during pregnancy due to their abuse
potential. Triptans are generally considered safe during the first trimester but not in the second and third
trimesters. Their use has been associated with uterine atony, increased risk of bleeding during delivery,
and increased risk of preterm birth

Question 15

Activities of daily living are self-care activities that are performed daily, such as eating, bathing,
dressing, transferring between the bed and a chair, and toileting, including bladder and bowel function.
Instrumental activities of daily living include activities necessary to live independently, such as using a
telephone, doing housework, preparing meals, taking medications properly, and managing finances.

Answer 15

.

Question 16

The effects of anorexia on the hypothalamic-pituitary axis can
cause which one of the following?
A) Bone loss
B) Elevated testosterone
C) Hyperglycemia
D) Hypothyroidism
E) Menorrhagia

Answer 16

A

***GH helps bone growth. Think of Amy getting the dexa scan.

Question 17

when to use racemic epi

Answer 17

Croup only
- dex and racemic epi.
(D/RE - Croup)

Question 18

asthma treatment in the ED

Answer 18

albuterol
steroids
IV mag if needed.

cRoup = Racemic epi
asthMa = Mag

Question 19

Cobb angle of what in a skeletally immature female should be referred

Answer 19

> 29 degrees.

Question 20

Absolute risk reduction
vs
Relative risk reduction

Prevalence vs incidence

Answer 20

ARR is the arithmetic difference in risk or
outcome rates between the treatment group and the control group. The relative risk reduction indicates how
much the risk or outcome was reduced in the treatment group compared to the control group.

prevalence = # of people found to be affected by a medical condition

incidence = # of new cases.

Question 21

sarcoid

Answer 21

think eye involvement.

bones are affected more because steroid use

Question 22

digital mucous cyst -

Answer 22

commonly occur on the dorsal surface of the distal phalanx.

Treatment options include intralesional corticosteroid injections, repeated puncture and
drainage, or surgical excision (SOR A).

Question 23

corticotropin stim test is for what?

Answer 23

steroid test - helps with adrenal insufficiency - like cushings.

Question 24

COPD - FEV1

Answer 24

This patient is in his forties without clear risk factors and has both an irreversible obstructive pulmonary
defect consistent with COPD
(FEV1 <80% of predicted and an FEV1/FVC ratio <0.70)

Question 25

MI in clinic. with O2 sat of 93%. do you use oxygen? and if so, how much? ``` A) No oxygen therapy B) Oxygen via nasal cannula at 2 L/min C) Oxygen via nasal cannula at 6 L/min D) 100% oxygen with a regular mask E) 100% oxygen with a nonrebreathing mask ```

Answer 25

A

Question 26

A 67-year-old female patient began taking a bisphosphonate for treatment of osteoporosis 2 years ago after a DXA scan revealed a T-score of –2.7. Her FRAX score showed a 10-year probability of hip fracture of 5%. You order a repeat DXA scan and her T-score is now –2.3 and her FRAX score is 3.5%. Which one of the following should you recommend to this patient regarding the duration of treatment with a bisphosphonate? A) Stop taking it now B) Continue taking it for 1 more year C) Continue taking it for 3 more years D) Continue taking it for 7 more years E) Continue taking it indefinitely

Answer 26

C treatment is indicated for patients at high risk of fracture, including those with osteoporosis, defined as a T-score of –2.5 or less, or osteopenia, defined as a T-score of –1 to –2.5 and a 10-year probability of hip fracture of at least 3% using the FRAX tool. She is still osteopenic

Question 27

46. For patients with atrial fibrillation, which one of the following comorbid conditions represents the strongest indication for thromboprophylaxis with warfarin (Coumadin), rather than a direct oral anticoagulant? A) A CHA2DS2-VASc score 3 B) End-stage chronic kidney disease C) A mechanical heart valve

Answer 27

C For patients with atrial fibrillation and end-stage chronic kidney disease, both apixaban (a direct factor Xa inhibitor) and warfarin are comparable options. However, warfarin is still recommended over a DOAC for valvular atrial fibrillation that occurs in the presence of moderate to severe mitral stenosis or a mechanical heart valve.

Question 28

``` 48. The most common symptom of alcohol withdrawal in the elderly is A) confusion B) seizures C) tachycardia D) tremor E) vomiting ```

Answer 28

A

Question 29

``` SBO most common cause in a 65 year old that had an appe in the past: A) Constipation B) Intestinal adhesions C) A neoplasm D) Ventral herniation E) Volvulus ```

Answer 29

B Intestinal adhesions are the most common cause of small bowel obstruction, accounting for 60%–75% of cases. Less common causes include neoplasms in 13%–20% of cases, herniation in 2%–15% of cases, and volvulus in <5% of cases. Severe constipation is a rare cause of small bowel obstruction.

Question 30

55. Which one of the following oral iron preparations is most effective for the treatment of iron deficiency anemia in a patient with non–dialysis-dependent chronic kidney disease? A) Ferric citrate (Auryxia) B) Ferrous fumarate C) Ferrous gluconate D) Ferrous sulfate

Answer 30

A The one exception is ferric citrate, which is highly efficacious in all patients with chronic kidney disease Intravenous iron preparations such as iron dextran are similarly effective in both groups and are considered the gold standard for the treatment of iron deficiency in patients on chronic hemodialysis FC and FD - think CKD

Question 31

Resting tremor think... | Essential tremor think...

Answer 31

``` resting = parkinsons essential = benign essential tremor ```

Question 32

asymptomatic COPD pt based on spirometry - what next? A) No treatment B) A long-acting anticholinergic C) A long-acting -agonist D) An inhaled corticosteroid E) Combination therapy with a corticosteroid and long-acting -agonist

Answer 32

There is no evidence from randomized, controlled trials to show that treating asymptomatic individuals, with or without risk factors for airflow obstruction, prevents future respiratory symptoms or reduces subsequent declines in lung function.

Question 33

The DSM-5 criteria for the diagnosis of adult ADHD require symptoms to have been present before age ***

Answer 33

12

Question 34

Which one of the following has been shown to be most effective in preventing diabetes in patients such as this? A) Participation in the National Diabetes Prevention Program B) Acarbose (Precose) C) Liraglutide (Victoza) D) Metformin (Glucophage)

Answer 34

A\ Patients who participate in long-term lifestyle intervention programs such as the CDC’s National Diabetes Prevention Program have an approximately 30% reduction in progression to type 2 diabetes. Metformin is also effective in reducing the progression to diabetes, but it is not as effective as lifestyle intervention programs for most patients.

Question 35

You tell the medical students that evidence suggests that tobacco cessation in pregnant women A) decreases the risk for cesarean delivery B) decreases the risk for preeclampsia C) decreases the need for epidural anesthesia D) increases infant birth weight E) increases the risk for preterm delivery 67.

Answer 35

D

Question 36

Delayed puberty in girls is defined as the absence of breast development by age ___. Typically, menarche starts 2.5 years after the onset of breast development, with an average age of 12.5 years (normal range 9–15 years). In girls with otherwise normal sexual development, the absence of menarche by ___ years of age should prompt an evaluation for primary amenorrhea.

Answer 36

13 15

Question 37

73. An elderly homeless male is brought to the emergency department. He is clearly hypothermic due to cold exposure and has superficial frostbite of his extremities. He is still conscious and shivering. In addition to rewarming him, which one of the following should you administer? A) Acetazolamide (Diamox Sequels) B) Amitriptyline C) Ceftriaxone D) Ibuprofen E) tPA

Answer 37

D Continued cold exposure leads to ice crystal formation, which causes cellular lysis, electrolyte abnormalities, and microvascular occlusion. Rewarming creates an inflammatory response. Ibuprofen is the most appropriate agent for the treatment of frostbite until the wounds heal or surgery is performed (SOR C). ``` Amitriptyline is used to treat the pain of immersion foot (also called trench foot), which is a nonfreezing injury that happens when the foot is exposed to prolonged wet conditions above 0°C (32°F). ``` tPA has a role in treating patients with frostbite, but it is used only to decrease the risk of amputation when rewarming patients with grade 3, grade 4, or deep frostbite (SOR B).

Question 38

t/f Medical testing prior to cataract surgery does not improve outcomes and is not recommended.

Answer 38

True

Question 39

what is central hypothyroidism?

Answer 39

Central | hypothyroidism is associated with a low TSH level and low T3 and T4 levels.

Question 40

MSM - how often do they get syphilis screening

Answer 40

annually

Question 41

adult-onset, severe and persistent, non-atopic asthma and aspirin sensitivity. This type of asthma is defined as intrinsic asthma and affects approximately 10% of patients with asthma. Patients with intrinsic asthma commonly also have ***

Answer 41

nasal polyps.

Question 42

is metformin safe when breastfeeding

Answer 42

yes

Question 43

can you give entresto if someone has angioedema

Answer 43

no

Question 44

A 17-year-old male presents to your office to be screened for celiac disease. His older sister was recently diagnosed with biopsy-confirmed celiac disease. He has had intermittent abdominal bloating but no other symptoms. Which one of the following is the current best practice to screen for celiac disease in this situation? A) No screening and treatment based on family history B) Antigliadin antibodies C) Endomysial antibodies D) Serum total IgA levels and IgA tTG antibodies E) Esophagogastroduodenoscopy with small bowel biopsies

Answer 44

D lots of people are asymptomatic, but given its genetic risks, it is worth checking.

Question 45

when do we start fluoride supplementation

Answer 45

6 months

Question 46

Which one of the following medications in her current regimen is most likely to cause an elevated calcium level? ``` A) Alendronate (Fosamax) B) Lithium C) Omeprazole (Prilosec) D) Sertraline (Zoloft) E) Spironolactone (Aldactone) ```

Answer 46

B Of the options listed, lithium is the only medication that can cause high calcium levels. In addition, thiazide diuretics, excluding aldosterone receptor antagonists such as spironolactone, often cause elevated calcium levels.

Question 47

The inability to use and make sense of numbers is a common problem encountered in physician-patient communication that can make it difficult to achieve shared decision-making. Which one of the following methods has been shown to be a helpful strategy when discussing numbers? A) Using relative risk instead of absolute risk B) Using icon arrays (pictographs) to show ratios C) Using percentages instead of frequencies D) Framing outcomes in either positive or negative terms, but not both

Answer 47

B use pictures

Question 48

A 30-year-old male has moderate to severe rectal pain that occurs with bowel movements and lasts for several hours. He reports minimal bright red blood on the toilet tissue. On examination he is noted to have an anal fissure in the posterior midline. Sitz baths and fiber supplementation have provided no relief, and topical nifedipine therapy did not resolve his symptoms. Which one of the following would be an effective treatment? A) beta-Blocker injection B) Botulinum toxin injection C) Corticosteroid injection D) Lidocaine injection E) Rubber band ligation

Answer 48

B An anal fissure is a longitudinal tear in the anoderm that occurs most often midline. The initial treatment is sitz baths and increased fiber intake. If there is no improvement, botulinum toxin is indicated. Topical nitroglycerin and diltiazem may also be used.

Question 49

The three cardinal symptoms of aortic stenosis are

Answer 49

angina, dyspnea, and presyncope or syncope. 75% of symptomatic patients die within 3 years unless they receive a valve replacement.

Question 50

what ist he preffered shingles vaccine

Answer 50

shingrix, NOT zostavax due to much higher efficacy than the live zoster vaccine.

Question 51

what age can the shingrix be given

Answer 51

CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine), separated by 2 to 6 months, to prevent shingles and the complications from the disease.

Question 52

``` new diagnosis of GAD - which med? Which one of the following is the first-line long-term treatment for this patient? A) Alprazolam (Xanax) B) Buspirone C) Duloxetine (Cymbalta) D) Imipramine (Tofranil) E) Quetiapine (Seroquel) ```

Answer 52

C SSRIs and SNRIs are recommended as first-line drug therapies because of their tolerability and efficacy compared with other drug therapies. Buspar is NOT an initial therapy.

Question 53

Which one of the following would be the best recommendation for a typical back strain? A) Ice B) Targeted exercises C) Oral analgesics D) Spinal manipulation E) Evidence does not support the superiority of any modality

Answer 53

E Recommendations for the treatment of back pain often include ice, targeted exercises, oral analgesics, and spinal manipulation. Although there is some evidence that certain modalities are better than placebo, there is very little evidence to show that one modality is superior to another in relieving back pain or shortening the course of the pain.

Question 54

T/f No thiazide in Chronic gout it is contraindicated

Answer 54

T

Question 55

HPV vaccine 2 or 3 doses?

Answer 55

Two doses of HPV vaccine are recommended for children and adolescents who start the series before 15 years of age. The second dose should be administered 6–12 months after the initial dose. If the patient is 15 years or older at vaccine initiation, then a three-dose series would be indicated at 0, 1–2, and 6 months.

Question 56

A healthy 29-year-old female sees you for a health maintenance visit. You recommend influenza vaccine but she declines because she has angioedema with ingestion of any eggs or egg products. She has an epinephrine auto-injector (EpiPen) and last used it approximately 9 months ago when she accidentally ingested a small amount of egg. She has not seen her allergist in more than 3 years but is planning to call soon for an appointment. Based on CDC guidelines, which one of the following would you recommend for this patient regarding influenza vaccination? A) No influenza vaccination regardless of vaccine form B) Vaccination only with inactivated influenza vaccine C) Vaccination with any licensed form of influenza vaccine D) Referral to an allergist for specific allergen testing prior to vaccination

Answer 56

C Patients with an egg allergy can receive any form of the influenza vaccine. Patients who have an angioedema reaction to egg products should receive the vaccine in an office setting. What kind of flu vaccine should I get if I have more serious reactions to eating eggs or egg-containing foods like cardiovascular changes or a reaction requiring epinephrine? If you are someone who has more serious reactions to eating eggs or egg-containing foods, like angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, you can get any licensed flu vaccine (i.e., any form of IIV, LAIV, or RIV) that is otherwise appropriate for your age and health status, but the vaccine should be given in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions. Are there still people with egg allergies who should not get flu vaccine? People with egg allergy can receive flu vaccines according to the recommendations above. A person who has previously experienced a severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, should not get a flu vaccine again.

Question 57

NASH with signs of cirrhosis. Laboratory Findings Platelets                              112,000/mm3 (N 150,000–450,000) Creatinine                             0.8 mg/dL (N 0.6–1.2) Hemoglobin A1c                        6.6% AST                                  68 U/L (N 8–48) ALT                                 55 U/L (N 7–55) Albumin                              3.2 g/dL (N 3.5–5.0) Bilirubin                              0.5 mg/dL (N 0.1–1.2) INR                                  1.0 (N <1.2) Which one of the following medications should be AVOIDED in this patient to reduce the likelihood of complications of her medical condition? A) Acetaminophen B) Atorvastatin (Lipitor) C) Ibuprofen D) Lisinopril (Prinivil, Zestril) E) Metformin (Glucophage)

Answer 57

C the diagnosis of cirrhosis should be confirmed and assessed by methods such as transient elastography, NSAIDs such as ibuprofen should be avoided in patients with cirrhosis due to the risk of renal insufficiency (SOR B). Statins can be safely used in compensated cirrhosis and may improve steatosis (SOR A)

Question 58

``` 119. Which one of the following types of hallucinations is associated with Parkinson’s disease? A) Auditory only B) Auditory and visual C) Hypnagogic D) Hypnopompic E) Visual only ```

Answer 58

E AH and VH = schizophrenia others are for sleep

Question 59

A 23-year-old male presents for evaluation of wrist pain after he fell while skateboarding. On examination he has left wrist pain with snuffbox tenderness. A radiograph of his wrist shows a fracture through the midportion of the scaphoid with 2 mm of displacement. Which one of the following would be the most appropriate treatment of this injury? A) A thumb spica cast B) A short arm cast C) A long arm cast D) Closed reduction followed by a thumb spica cast E) Surgical fixation

Answer 59

E Key - it is displaced... so surgery. No matter how small. displaced fractures should be treated with surgical fixation. ***The proximal pole of the scaphoid is entirely dependent on this distal blood supply. Nondisplaced fractures of the distal third of the scaphoid may be treated with a short arm thumb spica cast for 4–6 weeks. Middle and proximal fractures should be treated with a long arm thumb spica cast for 6 weeks, followed by a short arm thumb spica cast.

Question 60

rotterdam

Answer 60

1) polycysistc ovaries 2) anovulation 3) hyperandrogen ***2 of 3

Question 61

You are working in an urgent care clinic when a 68-year-old male with chronic hypertension sees you for refills of his medications. He has been out of his medication for the past month and could not get an appointment with his primary care physician for refills. His blood pressure is persistently 190/115 mm Hg, even after he has rested in a quiet room for 30 minutes. His blood pressure previously had been well controlled. He has a moderate headache but otherwise feels well. An examination, including a funduscopic examination, is normal. Which one of the following management options would be most appropriate at this time? A) Refill his usual medications and arrange for follow-up in 1 week B) Administer oral labetalol (Trandate) every 30 minutes until his blood pressure is <180/110 mm Hg C) Administer oral nifedipine (Procardia) every 30 minutes until his blood pressure is <180/110 mm Hg D) Administer sublingual nifedipine every 30 minutes until his blood pressure is <180/110 mm Hg E) Refer for immediate hospitalization for intravenous antihypertensive treatment

Answer 61

B This patient has a hypertensive urgency, defined as symptomatic acute severe hypertension without evidence of acute end-organ injury. Hypertensive urgencies may be managed in the ambulatory setting. Emergent intravenous treatment at the hospital is not indicated. This patient should be treated with an oral agent with a fairly rapid onset of action, such as clonidine, labetalol, captopril, or prazosin. Topical nitroglycerin is also an option. Nifedipine may cause unpredictable blood pressure reduction and should be avoided. The patient may be discharged to resume his usual medications after his symptoms have improved and his blood pressure is below 160–180/110 mm Hg, with follow-up within a week

Question 62

124. The U.S. Preventive Services Task Force recommends which one of the following for breast cancer screening? A) Annual screening mammography for women ages 40–75 B) Annual screening mammography for women ages 50–75 C) Biennial screening mammography for women ages 35–75 D) Biennial screening mammography for women ages 50–75 E) Biennial screening mammography for women ages 45–50 and annual screening mammography for women ages 51–75

Answer 62

D Current U.S. Preventive Services Task Force guidelines for breast cancer screening recommend biennial screening mammography for women ages 50–75 (B recommendation). Biennial screening mammography can be considered for women age 40–49 after discussing the risks and benefits with the patient (C recommendation).

Question 63

For patients with chronic kidney disease, current evidence shows that a low-salt diet A) decreases mortality B) lowers blood pressure C) increases proteinuria D) increases the time to end-stage renal disease and the need for dialysis

Answer 63

B Current evidence is lacking as to whether a low-salt diet leads to decreased mortality or an increased time to dialysis.

Question 64

At a routine visit, a 65-year-old male former smoker reports shortness of breath and a cough that has been worsening slowly over the last 6 months. On examination you hear bibasilar inspiratory crackles. An EKG, chest radiograph, and echocardiogram are normal. CT of the chest shows multiple bilateral patchy areas of consolidation. The most appropriate next step is to A) take a detailed history of medication use and lifetime environmental exposures B) start an antibiotic C) start furosemide (Lasix) D) start an inhaled short-acting -agonist as needed E) refer for pulmonary rehabilitation What is the diagnosis

Answer 64

pulmonary fibrosis - no wheezing, but crackles heard on exam. A

Question 65

If initiated today, which one of the following contraceptive methods does NOT require the use of backup contraception? A) Oral contraceptives B) An etonogestrel subdermal implant (Nexplanon) C) A copper-containing IUD (ParaGard) D) A levonorgestrel IUD (Mirena)

Answer 65

C Backup contraception is needed if a hormonal implant is placed more than 5 days from the start of the last menstrual period, and if a levonorgestrel IUD is placed more than 7 days from the start of the last menstrual period.

Question 66

Anti–smooth muscle antibodies are used to confirm **** Anti-centromere antibodies, a subset of ANAs, are more closely associated with ***

Answer 66

autoimmune hepatitis, systemic sclerosis (centaurs have a sclerosed system)

Question 67

While serving as team physician at a football game on a hot afternoon you are asked to evaluate an obese 17-year-old player who has begun limping. The player reports that he is very hot. An examination is normal except for a gastrocnemius spasm. You diagnose heat cramps. As you prepare to start treatment with isotonic fluid, stretching, and massage, the coach asks you how soon the athlete can return to play. You inform the coach that the player can resume participation A) now B) tomorrow C) upon resolution of his symptoms D) when his temperature is <38.3°C (100.9°F) E) after acclimating to the heat for 1 week

Answer 67

C Just heat cramps doesn't require much else

Question 68

Meniscus tear in a heatlhy 45 year old... what should you do?

Answer 68

A systematic review found that arthroscopic procedures for degenerative meniscal tears in middle-aged adults with little or no arthritis do not significantly improve long-term pain or function compared to conservative management consisting of physical therapy and a standardized exercise program.

Question 69

144. Which one of the following clinical features is a component of the STOP-Bang questionnaire used as a screening tool for obstructive sleep apnea? A) Blood pressure B) Pulse rate C) Resting oxygen saturation D) Smoking status E) Waist circumference

Answer 69

A P is for pressure S = snoring, T = tiredness, O = observed apnea, P = high blood pressure, B = BMI >35 kg/m2, A = age >50 years, N = neck circumference >40 cm, and G = male gender

Question 70

should 6 months old with new teeth use a fluoride toothpaste

Answer 70

yes, a low fluoride toothpaste

Question 71

A 36-year-old male presents with a 6-week history of a mildly pruritic rash in his groin. An examination reveals small red-brown macules and larger patches with a sharp border. A Wood’s lamp examination reveals coral-red fluorescence. Which one of the following would be the most appropriate treatment for this condition? A) 0.1% triamcinolone cream B) 2.5% hydrocortisone cream C) Nystatin cream D) Erythromycin gel E) Fluconazole (Diflucan) orally

Answer 71

D Erythrasma is a superficial infection caused by Corynebacterium minutissimum. It presents as small, red-brown macules that may coalesce into larger patches with sharp borders. It fluoresces coral red on Wood’s lamp examination. Cutaneous erythrasma is treated with erythromycin (topical, twice daily until the rash resolves, or oral, 250 mg four times daily for 2 weeks

Question 72

Swelling and pain in the retrocalcaneal region | is more characteristic of

Answer 72

retrocalcaneal bursitis.

Question 73

153. The U.S. Preventive Services Task Force recommends vision screening to detect amblyopia A) at 2 years of age B) at 3–5 years of age C) the summer before the child enters first grade D) once at 4–5 years of age and once at 8–9 years of age

Answer 73

B The U.S. Preventive Services Task Force recommends vision screening for all children at least once between 3 and 5 years of age to detect the presence of amblyopia or its risk factors (B recommendation).

Question 74

do you get the flu vaccine in pregnancy

Answer 74

YES

Question 75

if exposed to the flu and not vaccination - when should yo u get the vaccine

Answer 75

now, and still take tamiflu

Question 76

minimally displaced oblique right fifth proximal phalanx shaft fracture A) A rigid-sole shoe and weight bearing as tolerated B) A pneumatic brace and weight bearing as tolerated C) A short leg walking cast and weight bearing as tolerated D) A posterior splint and no weight bearing E) Immediate referral to an orthopedic surgeon and no weight bearing

Answer 76

A Lesser toe fractures such as this typically can be managed conservatively with buddy taping and a rigid-sole shoe Pneumatic brace = think avulsion fracture. metatarsal shaft fracture = posterior splint then walkign cast. (Bradley)

Question 77

The goal for treatment should be to lower the systolic and diastolic blood pressures below the 90th percentile for age, sex, and height. Once children are over 13 years of age, the target should be a blood pressure ***

Answer 77

<130/80 mm Hg.

Question 78

Rogain in women D) Minoxidil (Rogaine) 2% solution for 6 months E) Minoxidil 5% foam indefinitely

Answer 78

E = regrowth is noticeable around 6 months. d/c leads to loss of regrown hair. 2% solution/5%foam = females 5% solution = males

Question 79

what is osteochondritis desicans

Answer 79

OCD is defined as osteonecrosis of subchondral bone [1]. Specifically, OCD is a localized lesion in which a segment of subchondral bone and articular cartilage separates from the underlying bone, leaving either a stable or unstable fragment that may result in premature osteoarthritis OCD most often occurs in the knee, elbow, or ankle of the school-age or adolescent child where it causes pain. Plain radiographs are frequently diagnostic although magnetic resonance imaging (MRI) is typically necessary to further characterize the lesion

Question 80

should a type I diabetic fast?

Answer 80

Nope

Question 81

``` where to adminster epi during anaphylaxis A) Mid-outer aspect of the shoulder B) Mid-outer aspect of the buttocks C) Mid-outer aspect of the thigh D) Mid-outer aspect of the calf E) Lower medial abdominal wall ```

Answer 81

C

Question 82

A 43-year-old male with uncomplicated appendicitis prefers antibiotic therapy alone over surgical treatment. You advise him that this will increase his risk for which one of the following? A) A longer absence from work B) The need for pain medications C) Disability D) Subsequent surgery

Answer 82

D Evidence shows that antibiotic therapy alone may be a viable treatment option for patients with uncomplicated appendicitis. A meta-analysis of five randomized, controlled trials found that antibiotic treatment resulted in decreased complications, less need for pain medication, and less sick leave or disability compared with initial appendectomy. However, recurrence rates requiring surgery within a year may be as high as 40% compared to a less than 10% risk of repeat surgery in those who have an appendectomy.

Question 83

do you ever have to I&D a stye

Answer 83

yes if there for longer than 7 days

Question 84

You see a 60-year-old male for an initial office visit. He has a past history of a myocardial infarction. He has smoked two packs of cigarettes daily since the age of 18. He says that he enjoys smoking and has no plans to quit. Which one of the following would be the most appropriate response? A) I must advise you that smoking is very bad for your health B) Did you know that smoking increases your risk of another heart attack? C) What do you know about smoking’s effect on your health in general? D) Would it be okay if we discuss smoking? E) Can I schedule a follow-up appointment soon to focus on quitting smoking?

Answer 84

D precontempation

Question 85

do you attempt reduction or get an xray for nursemaids

Answer 85

attempt reduction first

Question 86

t/f - RSV child there is no clear advantage to deep nasal suctioning, which may also be associated with prolonged hospital stays. Routine nasal suctioning is indicated, however.

Answer 86

true Bronchodilators are not recommended in the treatment of RSV (level of evidence A).

Question 87

A 6-month-old female is brought to the emergency department by her parents with a 4-day history of fever, congestion, cough, shortness of breath, and decreased appetite. On examination of the lungs you note wheezes and crackles throughout. You also note subcostal retractions, an oxygen saturation of 91% on room air, and a respiratory rate of 42/min. A chest radiograph reveals peribronchial markings with no infiltrates. The parents say that the patient’s teenage cousin visited recently and was having “cold symptoms.” You suspect bronchiolitis. Which one of the following would you recommend next? A) Maintaining hydration and keeping oxygen saturation >90% B) Deep nasal suctioning C) Albuterol via nebulizer D) Broad-spectrum antibiotics E) Systemic corticosteroids

Answer 87

A

Question 88

USPSTF - does it recommend screening for illicit drug use

Answer 88

nope - an I

Question 89

t/f There is high-quality evidence | (SOR A) that omega-3 fatty acid supplementation has NO effect on cardiovascular disease

Answer 89

true

Question 90

183. A 36-year-old female with no significant past medical history presents to your office following a syncopal episode. A thorough history and physical examination are normal. Based on American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines, which one of the following would you recommend at this time? A) Reassurance, and follow-up only if she has another syncopal episode B) A troponin level C) Electrolyte levels D) A chest radiograph E) An EKG

Answer 90

E the evaluation of patients with syncope should include a thorough history and physical examination, as well as an EKG. Further studies would be indicated if the cause of syncope is unclear So A is the wrong answer. Do more testings

Question 91

``` Which one of the following is recommended for chronic refractory cough in this otherwise healthy male? A) Cyclobenzaprine B) Duloxetine (Cymbalta) C) Gabapentin (Neurontin) D) Lorazepam (Ativan) E) Propranolol ```

Answer 91

C gabapentin has demonstrated benefit for treating a refractory chronic cough after 4 weeks of treatment (SOR C). Chronic cough may be due to a hypersensitivity of the cough reflex, either centrally or peripherally. Cyclobenzaprine, duloxetine, lorazepam, and propranolol have not proven to be beneficial in reducing or eliminating chronic cough. Ativan can work for nausea though.

Question 92

keratitis of the eye is what?

Answer 92

inflammation of the CORNEA! think like from contacts etc...

Question 93

what is episcleritis of the eye?

Answer 93

There is a focal area of hyperemia of the episcleral blood vessels noted along the medial aspect of the eye. self limited

Question 94

190. A fully immunized 7-month-old male is brought urgently to your office after his parents noted a possible seizure. The mother says that the infant began to “shake all over” for about 3–4 minutes and then promptly fell asleep for about 20 minutes. When he awoke he was alert but fussy and crying. He has been ill for the last few days with a cough, congestion, decreased oral intake, and fevers up to 101°F. On examination he has an oral temperature of 38.3°C (100.9°F), a heart rate of 170 beats/min, a respiratory rate of 50/min, and an oxygen saturation of 97% on room air. The infant is fussy but consolable. His mucous membranes are moist, his tympanic membranes are clear, and he has a normal oropharynx. He has clear rhinorrhea. Examination of the heart is normal, and examination of the lungs reveals rhonchi and wheezes. He is moving all of his extremities normally. Which one of the following would be the most appropriate initial step in the evaluation of this child? A) A basic metabolic panel B) Radiography of the chest C) MRI of the brain D) Electroencephalography E) A lumbar puncture

Answer 94

Need to find the source of the fever... and he has a respiraotry condition so B There is a low risk that these children will have low sodium or glucose levels, and this would not predict seizure recurrence.

Question 95

193. A 39-year-old female presents to your office for evaluation of a left-sided headache. She notes pain in the temporal region and inferior to the zygoma. The pain is constant and dull but worsens with chewing. There is no history of recent trauma. Her past medical history includes fibromyalgia and her only medication is amitriptyline, 25 mg at bedtime. Her vital signs are within normal limits and she is afebrile. On examination you note tenderness to palpation over the temporalis region but no mass or cord. There is no swelling or edema of the head, face, or neck. Which one of the following is the most likely diagnosis? A) Giant cell arteritis B) A salivary stone C) Sinusitis D) Temporomandibular disorder E) Trigeminal neuralgia

Answer 95

D | TN is much more severe and in huge spasms of pain.

Question 96

196. Which one of the following patients should undergo screening for vitamin D deficiency? A) A 27-year-old male with recurrent major depressive disorder B) A 58-year-old male with a glomerular filtration rate of 28 mL/min/1.73 m2 C) A 69-year-old female with chronic osteoarthritis pain D) A 75-year-old female with recurrent falls E) An 88-year-old male with severe fatigue

Answer 96

B The measurement of vitamin D levels is recommended only for patients with decreased kidney function, various skeletal diseases, or hypercalcemia (SOR C). Vitamin D deficiency is common in patients with chronic kidney disease, and it is associated with cardiovascular morbidity and mortality in those patients. CKD - you lose Na and Ca... so low Ca, vitamin D could help raise you Ca... but if you are deficient, that won't help you.

Question 97

CURB 65 =

Answer 97

``` confusion uremia - BUN >19 RR >30 BP <90 or <60 65 ```