deck 18

Question 1

best evidence for physical activity in elderly

Answer 1

fall prevention

Question 2

preferred anticoagulant for venous thrombosis during pregnancy

Answer 2

LMWH (unfractionated heparin requires more monitoring and may increase risk of HIT)

Question 3

mediastinal widening in MCV crash patient

Answer 3

partial rupture of thoracic aorta

Question 4

most common presenting symptom of hodgkin’s lymphoma

Answer 4

painless lymphadenopathy

Question 5

pseudoaddiction

Answer 5

term used to describe patient behaviors that may occur when pain is undertreated.

Question 6

management of pt on narcotics using alcohol/illicit drugs

Answer 6

• expected that alcohol and illicit drugs not be used concurrently.

Question 7

OTC cough and cold products cannot be used in infants/childrens younger than…

Answer 7

2

Question 8

gout triggers

Answer 8

red meat, seafood, alcohol, nuts and beans (high in purines)

Question 9

food that reduces frequency of gout attacks

Answer 9

dairy products

Question 10

pharmacokinetic factors that change with age

Answer 10

• volume of distribution (due to increase in ratio of fat to lean body weight)
• liver metabolism, renal excretion
• *transdermal asborption DOES NOT CAHNGE.

Question 11

CBT for GAD?

Answer 11

Has been shown to be at least as effective as medication.

Question 12

pertussis diagnosis

Answer 12

nasopharyngeal culture + PCR testing

Question 13

preferred opioids for use in patients with ESRD

Answer 13

fentanyl (metabolized in liver) and methadone

Question 14

how to correlate A1C with glucose level

Answer 14

• 6.0 –> 120 mg/dl

- each percentage point corresponds to increase in 30 mg/dl rise in average glucose

Question 15

ABG with PE

Answer 15

PO2 and PCO2 decreased, pH elevated

Question 16

management of stable patient with SVT

Answer 16

first line –> vagal maneuvers

second line –> IV adenosone

Question 17

lab to order for vitamin d deficiency

Answer 17

25-hydroxyvitamin D

Question 18

ottawa ankle rules for radiographs

Answer 18

According to these guidelines, an ankle radiograph series is required only if there is pain in the malleolar zone and bone tenderness of either the distal 6 cm of the posterior edge or the tip of either the lateral malleolus or the medial malleolus. Inability to bear weight for four steps, both immediately after the injury and in the emergency department, is also an indication for ankle radiographs. Foot radiographs are required only if there is pain in the midfoot zone and bone tenderness at the base of the 5th metatarsal or the navicular, or if the patient is unable to bear weight both immediately after the injury and in the emergency department.

Question 19

most common cause of incontinence in elderly patients

Answer 19

detrusor instability

- can become worse after TURP

Question 20

best med for prophylaxis of traveler’s diarrhea

Answer 20

rifaximin

Question 21

treatment of choice for decontamination of most medication ingestions

Answer 21

• single dose of activated charcoal

- should be used within 1 hour of ingestion

Question 22

cutoff fasting plasma glucose for managing GDM

Answer 22

start meds if above 100

Question 23

DM meds for GDM

Answer 23

NPH + lispro BID

Question 24

asthma diagnosis

Answer 24

Need spirometry to diagnosis

Question 25

PMS syndrome caveat

Answer 25

symptoms are generally worse prior to menses, but can occur to some degree during menses and throughout the month

Question 26

PMS symptoms

Answer 26

anxiety, sleep disorder, fatigue, persistent depressed mood, decreased libido

Question 27

medicare part A covers

Answer 27

(hospital insurance) covers inpatient care in hospitals and skilled nursing facilities, hospice, and home health services.

Question 28

medicare part B covers

Answer 28

outpatient physician services, including office visits and home health services.

Question 29

medicare part D

Answer 29

prescription drug coverage.

Question 30

tetanus booster recommendation

Answer 30

Tdap (Due to waning immunity to pertussis. unless less than 5 years since last booster)

Question 31

management of isolated, enlarged cervical lymph node

Answer 31

1) Immediate biopsy is warranted if the patient does not have inflammatory symptoms and the lymph node is >3 cm, if the node is in the supraclavicular area, or if the patient has coexistent constitutional symptoms such as night sweats or weight loss. Immediate evaluation is also indicated if the patient has risk factors for malignancy. Treatment with antibiotics is warranted in patients who have inflammatory symptoms such as pain, erythema, fever, or a recent infection. 2) if no malignancy RF's, monitor node for 4-6 weeks.

Question 32

STEMI definition

Answer 32

ST-segment elevation of greater than 0.1 mV in at least 2 contiguous precordial or adjacent limb leads.

Question 33

most important goal in STEMI management

Answer 33

1) begin fibrinolysis less than 30 minutes after contact with health system - oral clopidogrel + chew large dose aspirin

Question 34

"enteric" meaning for drugs

Answer 34

coating that prevents dissolution or disintegration in the gastric environment

Question 35

drug you can't use anymore for head lice

Answer 35

Lindane (efficacy has waned + neurotoxic)

Question 36

thyroid nodule management

Answer 36

1) Measure TSH 2) IF suppressed, get a radionuclide thyroid scan --> if hot, FNA not needed. If cold, FNA 3) If TSH normal, get an FNA

Question 37

HEENT associated with DM

Answer 37

parotid gland enlargement + candidiasis + periodontal bleeding

Question 38

tooth erosion can also be a feature of...

Answer 38

GERD

Question 39

management of infected ingrown toenail

Answer 39

- partial avulsion of the medial nail plate and phenolization of the matrix at this visit

Question 40

if you can't get IV access then...

Answer 40

IO access. no contraindications. all IV drugs can be given IO.

Question 41

biguanide mehcanism

Answer 41

decrease hepatic glucose production + increase insulin sensitivity

Question 42

DPP-4 mechanism

Answer 42

prevent GLP-1 breakdown

Question 43

elevated LH/FSH with absent menses suggests...

Answer 43

ovarian failure

Question 44

treatment of hirsutism in premenopausal women

Answer 44

spironolactone

Question 45

best drug with osteoporotic women w/ breast cancer FH

Answer 45

raloxifine

Question 46

raloxifine MOA

Answer 46

estrogen agonist in bone, antagonist in uterus and breast

Question 47

management of benign FNA cytology with firm, fixed breast mass

Answer 47

excisional biopsy (biopsy results don't match clinical results)

Question 48

flashing lights + visual field defect

Answer 48

retinal detachment

Question 49

med that falsely depresses PSA levels

Answer 49

finasteride

Question 50

onset of somatization disorder

Answer 50

usually before 30

Question 51

test of choice if endoscopy is unsuccessful due to active bleeding

Answer 51

A technetium-99m blood pool scan to determine site of bleeding