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DIT Step 2 > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

2 day old M infant with hip instability found on Barlow maneuver, next step?

A

Hip US

If positive, then ortho consult

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2
Q

Screening with US for hip dysplasia in…

A

all girls born breech

optional: girls with positive family history, boys breech

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3
Q

contraindications for administering MMR/rubella vaccine

A 
pregnant (vaccine can cross placenta)
CD4+ count < 200
chemo
transplant recipients
congenital immundodeficiency
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4
Q

newborn with non-erythematous, non-pustule acne

A

acne neonatorum

don’t pop them

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5
Q

newborn with erythematous, pusutule acne

A

erythema toxicum neonatorum

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6
Q

thromboprophylaxis for 62 F x total hip replacement

A

10-35 days of LMW heparin (enoxaparin), fondapariunoux, or warfarin

NOT SQ heparin

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7
Q

when start to introduce solids into diet of infant

A

4-6 mo

otherwise extrusion reflex = push food out of mouth

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8
Q

hematologic abnLs MC in pt receiving testosterone replacement

A

erythrocytosis

check HCT before tx, Q3-6 mo x 1 year, then yearly

risk VTE with increased HCT

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9
Q

borderline personality disorder

A

female
splitting
cutting

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10
Q

treatment plan for plantar fasciitis

A
  1. stretching
  2. avoid flat shoes and walking barefoot
  3. heel shoe inserts
  4. NSAIDs
  5. steroid inj
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11
Q

severe preeclampsia –> started on magnesium –> less responsive, decreased central reflexes –> administer ___?

A

MgSO4 toxicity –> 1st give calcium gluconate

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12
Q

62 M never had VZV as a child or vaccine, should he receive the VZV vaccine?

A

yes, he would benefit

FDA approved x age 50+ regardless of previous VZV or not

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13
Q

do not give VZV vaccine to

A

pregnant and immunocompromised

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14
Q

findings of PMR (polymyalgia rheumatica)

A 
> 50 yo
bilateral proximal
girdle joints
morning stiffness
lasts > 30 m
elevated ESR
sx relieved with low-dose PO steroids
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15
Q

9 yo boy with fatigue, tonsillar hypertrophy, mod OSA –> next best step tx?

A

kid: adenotonsillectomy
CPAP if surgery contraindicated

adult: CPAP

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16
Q

18 F no period for past 2 months, next step

A

BhCG

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17
Q

52 F postmenopausal on long-term (>3 mo) prednisone for severe RA –> how care for bone health?

A

start bisphosphonate
bone building exercises
milk/yogurt PO calcium (1200 mg daily)
stop smoking

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18
Q

bone health for > 50 M on prednisone

A

start bisphosphonate
1200 mg calcium daily
800 IU vit D daily
stop smoking

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19
Q

78 M with DM, HTN presents with HFrEF, which of meds (lisinopril, pioglitazone ,glipizide, saxagliptin) are contributing to his CHF?

A

piogliatzone can casue fluid retention

  • complicates CHF
  • contraindicated in pt w/ NYHC III or IV
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20
Q

6 mo M with low grade fever, vom, and diarrhea –> tx?

A

regular age appropriate diet = continued breastfeeding

if more dehydrated, PO rehydration THEN start bf

*simple sugars (juice, soda) make diarrhea worse due to increased osmotic load in gut

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21
Q

28 F hx HPV warts, wants HPV vaccine

A

no, only up to age 26

start M+F 11-2 yo

***if she were <26 yo and had warts and non-manog relationship these things do NOT exclude her from the vaccine, ONLY AGE

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22
Q

62 M cramping left calf, improves with rest, dec pedal pulses, shiny and hairless shins –> next step

A

ABIs

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23
Q

positive ABI ratio

A

ankle/arm

< 0.90 = PAD

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24
Q

pruritic LEs, no obvious rash –> dx and tx

A

xerosis
MC cause of pruritis in the absence of pustular lesions

hydration with topical emollients

25
Q

62 M hx of lung cancer has sCa2 15.1 mg/dL with nL serum albumin, polyuria, weakness –> next bes step

A
  1. NS hydration (promote Ca2+ diuresis in urine)
  2. calcitonin (quick, dec Ca2+ in hours)
  3. bisphosphonate (dec bone Ca2+ reabs)

PTHrP from squamous

26
Q

8 mo F with antecubital and popliteal fossae rash, bother has it and uses pimecrolimus, what tell parents?

A

do not use pimecrolimus until 2 yo

  1. topical emollients
  2. low low corticosteroid topical
27
Q

25 M producit ve cough x 7 d, no fever, no SOB, nL lung exam, acute bronchitis –> tx

A

supportive

28
Q

42 F dx with RA, infliximab…what test before starting?

A 
TB skin (PPD)
hepatitis B surface antigen
29
Q

65 M memory loss, wax/wane alertness, AH and VH, falls, resting tremor, mod rigidity, nL labs and nL CT –> Dx

A

Lewy Body Dementia

dementia, fluctuation cognition, hallucinations, Parkinsonism

30
Q

22 F sexually active, gradually worsening dysuria and UTI, no fever, no growth bacteria on UC, no improvement with nitrofurantoin –> likely

A

G/C

31
Q

tx DTs

A

benzos

32
Q

2 mo M, exclusively BF so needs…

A

vitamin D

400 IU/daily in 1st week of life

33
Q

26 M withdrawn, stops bathing, hear voices, no dep or mania, x 2 mo –> dx

A

schizophreniform

1-6mo

34
Q

mother with chronic hep B wants to breastfeed her baby, what do you tell her?

A

okay!

35
Q

22 F lethargy, irr menses, abd pain, xerosis, parotid gland swelling, erosion on dental enamel, B/P –> tx

A

CBT counseling

SSRI - fluoxetine

36
Q

23 M asthma, SABA 3x/wk –> tx

A

SABA prn
start low dose ICS

> 2/wk = mild persistent asthma

37
Q

USPSTF recs on AAA screening

A

male
65-75
smoking history
one time abd US

38
Q

42 F gnawing mid-epigastric pain x 3 weeks, improves with eating

A

duodenal ulcer

h. pylori

39
Q

42 F sora areas on proximal nail folds over several fingers, dishwarsher –> tx

A

chronic paronychia

  • avoid irritants
  • topical med/high corticosterodis
40
Q

21 F 26w GA frequent migraine HA, but AVOID ___ med

A

imitrex (triptans) = vasoCNX uterine and placental vessles

ergotamine = uterine contx and abortifacent

41
Q

migraine meds contraindicated in pregnancy

A

triptans

ergotamines

42
Q

22 M with meningococcal meningitis, ppx for roommate?

A

rifampin PO
cipro PO
or
IM ceftriaxone

43
Q

66 F TSH 11.0, free T4 nL –> dx

A

subclinical hypothyroidism

  • likely to progress to frank hypothy
  • assoc with CVD and inc LDL
  • tx if TSH > 10
44
Q

37 obese M diagnose type 2 –> tx

A

lifestyle changes
start metformin
(warn about gi upset)

45
Q

ottawa ankle rules

A
  • malleolar zone pain
  • unable to bear weight
  • tenderness at base of 5th metatarsal or navicular
46
Q

68 F PPI x GERD, SE?

A

dec Ca2+ absorption –> inc risk hip fx and osteoporosis
inc risk CAP
inc risk c. diff colitis
dec b12 absorption

47
Q

49 F abnl periods, dark blood at os, BhCG neg, HGB nL –> next step

A

endometrial biopsy

***in real life, endometrial US/transvaginal US

48
Q

12 M bilatereal heel pain x 3-4 m, soccer, worse in practice, b/l posterior heel pain during dorsiflexion of ankles –> dx

A

calcanealapophysitis (Sever disease)

- inflammation due to rapid expansion of growth plate and oversue in sports

49
Q

tx calcanealapophysitis

A

rest
RICE
NSAIds

50
Q

22 F G1PO 38wGA, routine, fundus 40 cm, efw 4200g –> next best step

A

await spontaneous labor

C/S, no trial labor if:

  • 4500 g + GDM/DM
  • 5000 g + no diabetes
51
Q

86 M progressive symmetric HL –> MC HL

A

conductive high-frequency HL

hard time F>M voices

52
Q

42 F cough x 3w, fatigue, sore throat, nasal congestion, low grade fever, no SOB, dramatic fits, post-tussive emesis, no smoking, no immunizations, excessive lacrimation, conj injection, nL CXR –> dx

A

pertussis

  • lasts weeks
  • post-tussive emesis
  • lacrimation
  • conjucntival inj
  • nL CXR + exam
53
Q

2 F walking with mild in-toeing, next best step?

A

reassurance

54
Q

48 F 2 cm darkly pigmented macule on forearm, IRR shape, variation color, enlarging –> next best step

A

excisional biopsy with 1-2 mm rim of nL appearing skin

55
Q

25 F acute pelvic pain x 5d, sexually active, tenderness and fullness of R side –> imaging

A

transvaginal US = best initial study of F pelvic pain

also BhCG lab

56
Q

38 M father CRC, when begin CRC screening?

A

40 yo
OR
10 y younger than earliest age onset
(whichever is first)

57
Q

41 M HTN, HLD severe pain R toe

A

gout

58
Q

tx acute gout attack

A
  • NSAIDs (naproxen 500 mg BID OR indomethacin 50 mg TID)
  • colchicine if first 12-24 h
  • STOP HCTZ

DIT Step 2 (8 decks)

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