December

Question 1

Which are the two most common causes of CAP?

a) S. pneumoniae
b) H. influenzae
c) M. pneumoniae
d) Group A strep
e) M. catarrhalis

Answer 1

Choices a) S. pneumoniae and c) M. pneumoniae are the most common causes

Note: H. influenzae is common in smokers

Question 2

A patient presents with pain, CVA tenderness, nausea, vomiting. What is the likely diagnosis?

a) UTI
b) kidney stone
c) gallbladder inflammation
d) pyelonephritis

Answer 2

Answer: d) pyelonephritis (per Hollier 1st choice)

Note: second choice kidney stone; third choice UTI

Question 3

Osgood-Schlatter Disease is a common cause of knee pain during adolescence due to rapid bone growth. What diagnostics are required?

a) X-ray
b) CT
c) none
d) MRI

Answer 3

Answer: c) none (diagnosis can be made based on clinical examination)

Question 4

Treatment for Osgood-Schlatter Disease might include (choose all that apply):

a) muscle relaxers
b) Tylenol/Ibuprofen
c) ice
d) stretches & strengthening activities for the quadricep

Answer 4

Answer: b,c,d (management does NOT include muscle relaxers)

Question 5

How long does Osgood-Schlatter Disease take to resolve typically?

a) 1 month
b) 6 months
c) 12 months
d) 18 months

Answer 5

Answer: c) 12 months

Note: child may continue sports participation as tolerated

Question 6

What drug can cause rebound headaches in the management of migraines?

a) toradol (ketorolac)
b) Sumatriptan (Imitrex)
c) depakote ER (divalproex sodium)
d) Ergots (dihydroergotamine)

Answer 6

Answer: b) sumatriptan (imitrex)

Note: overuse of abortive medications can cause rebound headaches

Question 7

What is NOT true of triptans?

a) they are safe to use in uncontrolled HTN/heart disease
b) cause vasoconstriction
c) metabolized by liver
d) contraindicated with MAOI use

Answer 7

Answer: a) they are safe to use in HTN/ heart disease

triptans are contraindicated in ischemic heart disease, CAD, uncontrolled HTN, PVD, CVD

Question 8

A patient presents after swimming with: ear pain, normal TM, afebrile. What is the likely diagnosis.

a) otitis externa
b) otitis media

Answer 8

Answer: a) otitis externa

“Swimmers ear” occurs due to excessive moisture and causes pain on the external ear, redness/edema in the ear canal, discharge, normal TM, and afebrile.

Question 9

First line treatment for otitis externa?

a) amoxicillin
b) ofloxacin
c) clindamycin
d) cefdinir

Answer 9

Answer: b) ofloxacin drops (if bacterial)

If fungal: clotrimazole drops

Question 10

Most common bacterial organism for otitis externa?

a) aspergillus
b) streptococcus pneumoniae
c) pseudomonas
d) H. influenzae

Answer 10

Answer: c) pseudomonas

Other bacterial causes are: staphylococcus & streptococcus

Question 11

During the ACCOMPLISH trial for blood pressure control, what combination of drugs was found to be the most effective?

a) HCTZ+ lisinopril
b) metoprolol+chlorthalidone
c) benazepril+amlodipine
d) amlodipine+furosemide

Answer 11

Answer: c) benazepril+ amlodipine

Question 12

Celiac disease is characterized by an autoimmune attack on the small intestine where the individual cannot tolerate gluten. This is is manifested by bloating, n/v/d, abdominal pain, and weight loss. What diagnostics are NOT indicated?

a) serology testing (antibodies)
b) genetic testing (HLA-DQ2 & HLA-DQ8)
c) barium enema
d) endoscopy (biopsy)

Answer 12

Answer: c) barium enema is NOT indicated for diagnosis

Question 13

What type of statin is indicated for each patient listed below:

age <75 with established ASCVD
age >75 with established ASCVD

Answer 13

Answer:
o High intensity statin: < 75 y/o
o Moderate intensity statin: > 75 y/o

Question 14

True or false, a patient with LDL >190 should be on a statin?

Answer 14

Yes, high intensity.

Question 15

What are the lipid ideal levels:

Total:
LDL:
HDL:
Trigs:

Answer 15

Answer:

Total cholesterol: less than 200
LDL: less than 100
HDL: 40+ (men) and 45+ (women)
trigs: less than 150

Question 16

Assign the following patients the appropriate statin:

1) DM age 40-75 ASCVD risk <7.5% w/o other risk factors
2) DM age 40-75 ASCVD risk <7.5% with other risk factors
3) DM age 40-75 ASCVD risk 7.5%

Answer 16

Answer:

1)ASCVD risk < 7.5% without other risk factors: Moderate intensity statin
2) ASCVD risk < 7.5% with other risk factors: High intensity statin
3) ASCVD risk > 7.5%: High intensity statin

Question 17

A 45 year old diabetic patient has an ASCVD risk of <7.5% without other risk factors, what type of statin should he be on?

a)low intensity
b) moderate intensity
c) high intensity

Answer 17

answer: moderate intensity statin

Question 18

ASCVD Risk & statin indication:

1) Risk 7.5% to 20% without other risk factors

2) Risk 7.5% to 20% with other risk factors

3) Risk > 20% with or without risk factors

Answer 18

1) Risk 7.5% to 20% without other risk factors: Moderate intensity statin
2) Risk 7.5% to 20% with other risk factors: High intensity statin
3) Risk > 20% with or without risk factors: High intensity statin

Question 19

What ages do we evaluate ASCVD risk (what is the calculator indicated for in terms of age)?

Answer 19

Ages 40-79 on the website (will accept ages 20+ but cannot calculate)

Question 20

ASCVD risk in a 30 year old is 22%, you should:

a) initiate low intensity statin
b) initiate moderate intensity statin
c) initiate lifestyle changes
d) no treatment required, classification is not accurate until age 40

Answer 20

Answer: c) initiate lifestyle therapy first

Question 21

A patient presents with a boggy/tender/warm prostate, what is the likely diagnosis?

a) prostatitis
b) prostate cancer
c) bleeding internal hemorrhoids
d) gonorrhea

Answer 21

Answer: a) prostatitis

Other symptoms: low back pain, urinary frequency/urgency/dysuria/decreased stream, fever, chills, pain with defecation and ejaculation

Question 22

What is the most common cause of acute prostatitis?

a) enterococci
b) E. coli
c) pseudomonas
d) STIs

Answer 22

Answer: b) E. coli (65-80% of all cases)

Question 23

Treatment options for prostatitis include all of the following EXCEPT:

a) ciprofloxacin (fluoroquinolone)
b) bactrim (sulfa agent)
c) tetracycline (doxycycline)
d) cephalosporins (cefixime)

Answer 23

Answer: all of the following are acceptable treatment options

Question 24

A patient presents with post-void drip as the chief complaint, what is the likely diagnosis?

a) STI
b) BPH
c) prostatitis
d) bladder spasm

Answer 24

Answer: b) BPH

Question 25

A nerve injury involving toe walk is which spinal process/location: a) L4 b) L4/L5 c) S3 d) S1

Answer 25

Answer: toe walk is associated with S1 Note: heel walk (L4/L5); squat (L4); big toe strength (L4/L5)

Question 26

Patient was on vacation in Bali and has travelers' diarrhea. What is the most likely organism causing this? a) shigella b) salmonella c) E. coli d) vibrio cholerae

Answer 26

Answer: c) E. coli Note: campylobacter jejuni (second most common)

Question 27

What are shin splints? a) microvascular tears in the tendons between the ankle/knee b) hairline fractures of the tibia c) inflammation of muscles/tendons/bone around tibia d) nerve damage due to elevated glucose as seen in DM

Answer 27

Answer: c) inflammation of muscles/tendons/bone around tibia Typically from repetitive movement, improper foot wear, flat feet. The pain can be sharp or dull and can occur during exercise or at rest.

Question 28

Which is not a treatment component for shin splints? a) rest b) ice c) compression d) massage

Answer 28

Answer: d) massage Other treatment options include: NSAIDs, supportive shoes, stretching

Question 29

How long should a patient with shin splints be pain free for before returning to exercise?

Answer 29

2 weeks

Question 30

Positive straight leg test can show:

Answer 30

Disc herniation

Question 31

What is a description of cluster headache symptoms? a) band-like squeezing b) knife to head c) burning d) dull pain clustered to one side of the head

Answer 31

Answer: b) knife to the head other symptoms are eye tearing

Question 32

Which HIV med crosses the blood-brain barrier?

Answer 32

NRTI (Zidovudine)

Question 33

What HIV treatment approach is the most effective for reducing cognitive issues long term?

Answer 33

HAART

Question 34

The ISH committee hypertension guidelines for initiating treatment (what BP)?

Answer 34

140/90

Question 35

JNC 8 Hypertension guidelines: Age <60 treat BP if: Age 60+ treat BP if: If DM treat BP if ______ (despite age)

Answer 35

If < 60 y/o treat BP > 140/90 If > 60 y/o treat BP > 150/90 If DM treat BP > 140/90 despite age

Question 36

What medication class works best to lower isolated systolic hypertension?

Answer 36

CCBs or thiazides

Question 37

What is the Somogyi effect? a) hyperglycemia between 0500-0600 related to an increase in growth hormone at night b) hypoglycemia at night with rebound hyperglycemia in the morning

Answer 37

Answer: b) hypoglycemia at night with rebound hyperglycemia in the morning is called the Somogyi effect

Question 38

The Somogyi effect is best managed by what change in insulin? a) decrease nighttime insulin b) increase nighttime insulin

Answer 38

Answer: a) decrease nighttime insulin With Somogyi there is too much PM insulin which causes hypoglycemia, glucagon is released which leads to hyperglycemia in the morning

Question 39

What is the Dawn phenomenon? a) hyperglycemia between 0500-0600 related to an increase in growth hormone at night b) hypoglycemia at night with rebound hyperglycemia in the morning

Answer 39

Answer: a) hyperglycemia between 0500-0600 related to an increase in growth hormone released at night

Question 40

The Dawn phenomenon is best managed by what change in insulin? a) decrease nighttime insulin b) increase nighttime insulin

Answer 40

b) increase nighttime insulin

Question 41

Which blood glucose rises first in DM2? a) pre-prandial b) post-prandial c) fasting

Answer 41

Answer: b) post-prandial

Question 42

What FEV1/FVC is considered diagnostic for COPD?

Answer 42

FEV1/FVC <0.70 is considered diagnostic

Question 43

What are the GOLD classifications for COPD in terms of severity? 1) mild 2) moderate 3) severe 4) very severe

Answer 43

1) mild >80% 2) moderate 50-80% 3) severe 30-50% 4) very severe <30%

Question 44

Treatment initiation for COPD is: a) LABA + ICS b) LAMA/LABA c) LAMA+ ICS d) LAMA or LABA

Answer 44

Answer: d) LAMA or LABA is appropriate for treatment initiation reliever SABA (albuterol)

Question 45

What is track 1 initiation for asthma treatment: a) SABA as needed b) daily SABA c) LAMA+ICS as needed d) LABA+ ICS as needed

Answer 45

Answer: d) LABA+ICS as needed step up is: LABA+ICS daily

Question 46

Treatment of asthma as indicated with peak flow <60% should be treated with what?

Answer 46

Oral steroids

Question 47

What is the most common composite material for kidney stones?

Answer 47

answer: calcium oxalate

Question 48

Appropriate diagnostics for mono (EBV virus), choose all that apply: a) monospot b) CBC w/ diff c) rapid strep d) U/S for spleen & liver enlargement

Answer 48

Answer: all of the above are appropriate

Question 49

What advice is appropriate for a patient diagnosed with mono? Choose all that apply: a) exercise as tolerated b) rest c) tylenol/ibuprofen d) adequate fluids

Answer 49

Answer: b, c, d Rest, tylenol/ibuprofen, and fluids are indicated. Patient should NOT have any exercise/sports for minimum of 3 weeks due to risk for spleen rupture

Question 50

Strep throat treatment first line: a) levofloxacin b) cephalexin c) penicillin

Answer 50

Answer: c) penicillin (Pen V, Pen G, amoxicillin)

Question 51

What treatment is appropriate for strep throat with a penicillin allergy? a) amoxicillin b) macrobid c) azithromycin

Answer 51

Answer: c) azithromycin other options are cephalexin

Question 52

If a patient has strep and mono what is the treatment?

Answer 52

azithromycin

Question 53

In hypothyroidism, what labs are expected: TSH: T3/T4:

Answer 53

Hypothyroidism: TSH: high T3/T4: low

Question 54

In hyperthyroidism, what labs are expected: TSH: T3/T4:

Answer 54

Hyperthyroidism: TSH: low T3/T4: HIGH

Question 55

How is dosage determined for managing hyperthyroidism and medications (what lab)? a) TSH b) T3 c) free T3 d) T4 e) free T4

Answer 55

Answer: e) free T4

Question 56

What are the ranges for A1C (normal, prediabetic, diabetic)?

Answer 56

Normal <5.7% Prediabetic 5.7-6.4 Diabetic 6.5+

Question 57

Ranges for fasting blood glucose (normal, prediabetic, diabetic)?

Answer 57

Normal <100 Prediabetic 100-125 Diabetic 126+

Question 58

What ABI is diagnostic for PAD?

Answer 58

ABI <0.90

Question 59

True or false, allergic sinusitis is worsened with exposure to allergen?

Answer 59

True

Question 60

Top 3 causes of acute bacterial rhiunosinusitis (URI symptoms which are 10+ days and have a "double sickening"):

Answer 60

S. pneumoniae, H. influenzae, M. catarrhalis

Question 61

What is the first line treament for bacterial rhinosinusitis? a) augmentin b) clindamycin c) levofloxacin d) doxycycline

Answer 61

Answer: a) augmentin

Question 62

If a patient is allergic to penicillin but has acute bacterial rhinosinusitis, which treament is NOT appropriate? a) augmentin b) doxycycline c) clindamycin d) levofloxacin

Answer 62

Answer: a) augmentin because it is a penicillin drug

Question 63

When is sinusitis referred?

Answer 63

Refactory to antibiotics

Question 64

When is sinusitis referred (choose all)? a. Refractory to abx b. Recurrent c. Bilateral facial/pain d. Concern for etiology other than chronic sinusitis e. Periorbital cellulitis

Answer 64

Answer: A,B,D,E Refer if: a. Refractory to abx b. Recurrent d. Concern for etiology other than chronic sinusitis e. Periorbital cellulitis If UNILATERAL facial pain

Question 65

A patient presents with a dog bite from 1 hour ago, what are appropriate treatment approaches (choose all that apply)? a) cleanse with NS b) search for foreign body c) suture d) tetanus shot e) Augmentin

Answer 65

Answer: a,b,d,e The wound should be cleansed with NS, search for foreign body, tetanus shot given, augmentin provided. Area should NOT be sutured unless on face (time is a critical consideration in this as well-rule of thumb is if anything greater than 6-12 hours do not suture)

Question 66

Common risk factor of PAD (choose all that apply): a) female gender b) age <40 c) smoking d) diabetes

Answer 66

Answer: c) smoking and d) diabetes

Question 67

Common cause of ED:

Answer 67

Psychological

Question 68

Relationship between statin use and liver "stress"

Answer 68

Less than 1% of patients will have an issue

Question 69

Diabetic medications that target PPG (choose all that apply): a) TZD b) DPP-4i c) mealtime insulin d) SGLT-2i e) GLP-1

Answer 69

Answer: all of the above Note: SGLT-2i also target fasting blood glucose

Question 70

Diabetic medication class that targets fasting blood glucose?

Answer 70

Sglt-2 inhibitiors (Invokana, Farxiga, Jardiance)

Question 71

Your patient is taking metformin and a sulfonylurea (Glimepiride) and is having frequent occurrences of hypoglycemia, you should: a) decrease dose of metformin b) decrease dose of sulfonylurea c) decrease dose of both

Answer 71

b) decrease dose of sulfonylurea

Question 72

If a patient was immunized against Hep B, and now immune, what type of test result would they have? a) anti HBsAg positive b) anti HBcAg positive c) HBsAg positive d) anti HBc IgG

Answer 72

Answer: a) anti HBsAg positive This means the surface is reactive due to the immunization, but not the core. IgG would indicate a "core" infection that is resolved (if anti-HBs is positive) and chronic if IgG is positive along with HBsAg positive

Question 73

Most common transmission type for hepatitis B?

Answer 73

blood, boy fluids, sexual contact

Question 74

Most commmon organism responsible for nosocomial pneumonia?

Answer 74

Nosocomial (think hospital acquired) organism is pseudomonas aeruginosa

Question 75

Asthma FEV/FVC classification in terms of severity: 1) mild intermittent: 2) mild persistent: 3) moderate persistent

Answer 75

1) mild intermittent: over 85% of predicted value 2) mild persistent: over 80% of predicted value 3) moderate persistent 75-80% of predicted value Remember COPD is <0.7 of predicted

Question 76

Track 2 treatment of asthma (not preferred track) for being uncontrolled with SABA use alone should be: a) take ICS when SABA taken b) take ICS+LABA as needed c) take ICS+ LABA daily d) take ICS+LAMA

Answer 76

Answer: a) take ICS when SABA is taken

Question 77

When is a low intensity statin indicated: a) during pregnancy b) for a 30 year old patient with an ASCVD risk of 22% c) if high or moderate intensity statins are not tolerated d) HDL is 40

Answer 77

Answer: c) For patients who cannot tolerate a high or moderate intensity statin

Question 78

First line approach to low back pain: a) muscle relaxers b) opioids c) NSAIDs d) antidepressants

Answer 78

Answer: c) NSAIDs

Question 79

Which medication type does NOT raise blood pressure: a) sleep meds b) hormonal birth control c) NSAIDs d) SSRIs e) decongestants

Answer 79

Answer: a) sleep meds

Question 80

24 year old patient has had repeated BP readings of 145/83 (range but close to that) you check it today and it is elevated, you: a) encourage lifestyle changes and reevaluate in one month b) suggest a low sodium diet c) start on metoprolol low dose d) start on HCTZ

Answer 80

Answer: d) start on HCTZ Note: lifestyle changes should also be implemented, but you cannot wait a month to initiate treatment

Question 81

Patient is consistently having elevated fasting sugars, taking an intermediate insulin (Lantus). What should you do? a) increase lantus dose b) start on sulfonylurea c) start on mealtime fast-acting insulin (Novolog) d) start on GLP-1 inhibitor

Answer 81

Answer: c) start on mealtime fast-acting insulin (Novolog) at the largest meal of the day initially, can increase to other meals if needed

Question 82

Patient has persistent AFIB (AF continues for 7+ days) and is on warfarin, they ask when they can stop, you tell them: a) once they feel better b) once their INR is 1.5 c) they will be on it indefinitely d) now so that you can evaluate whether they are a candidate for cardioversion

Answer 82

Answer: c) they will be on it indefinitely INR goal is 2-3 if nonvalvular Afib; Other agents are preferred over warfarin unless the patient has valvular Afib

Question 83

Patient takes the prescribed 3 doses of nitroglycerin for angina but the pain persists, they should: a) take 81 mg aspirin b) drive to the ER c) call 911

Answer 83

Answer: c) call 911

Question 84

Patient awoke with redness to eyes and mucopurulent drainage, that tells you it is: a) viral b) bacterial c) allergic d) fungal

Answer 84

Answer: b) bacterial

Question 85

A child has valve stenosis, what are the initial steps (choose all that apply)? a) surgery to open valves b) valve replacement c) EKG d) echo e) check clotting factors (PT, INR, PTT)

Answer 85

Answer: c) EKG & d) echo

Question 86

What is the most common bacteria responsible for UTIs?

Answer 86

E. coli

Question 87

Scarlet fever associated heart issues are from what illness commonly?

Answer 87

Group A strep

Question 88

First line treatment options for hypertension (choose all that apply): a)ACE-I b) beta-blockers c) calcium channel blockers d) thiazide diuretics

Answer 88

Answer: a) ACE-I, d) thiazide diuretics, c) CCB