ITE 2019

Question 1

What is an appropriate alternative to augmentin for patients with PCN allergy?

Answer 1

doxycycline

Question 2

Adenopathy at what site is most linked to cancer?

Answer 2

Supraclavicular adenopathy is associated with a high risk of intra-abdominal malignancy in both adults and children, with studies finding 34%–50% of these patients having a malignancy.

Question 3

PAtients over what BMI can be referred for bariatric surgery?

Answer 3

Patients with a BMI 40 kg/m2 should be referred for consideration of bariatric surgery (SOR B).

Question 4

What kinds of exposures increase risk of asthma? decrease risk? (think viruses, etc)

Answer 4

Those who are exposed to respiratory syncytial virus as an infant have an increased risk, whereas those who are exposed to a high microbial environment have a lower risk than those without such exposure

Question 5

Flexion, abduction, external rotation (FABER) test that produces pain at the sacroiliac joint, lumbar spine, and posterior hip

Answer 5

sacroiliac joint dysfunction

Question 6

FABER test produces pain to the groin

Answer 6

While femoroacetabular impingement may be associated with a positive FABER test, it would produce pain in the groin

Question 7

What is the tx for acute epidiymitis?

Answer 7

In sexually active adults <35 years of age, gonorrhea and Chlamydia are the most common causative organisms of acute epididymitis. Ceftriaxone, 250 mg intramuscularly or intravenously once, with oral doxycycline, 100 mg twice daily for 10 days, would be the appropriate treatment for acute epididymitis (SOR C).

Question 8

Signs of acute epidiymitis?

Answer 8

scrotal pain and swelling
improvement with lifting scrotum (Prehn’s sign)
fevers/chills

Question 9

What are top three tx for manic or hypomania?

Answer 9

Lithium, olanzapine, valproate

Question 10

What is the treatment for olecranon bursitis?

Answer 10

padding, rest, ice

Question 11

presence of RBC casts, hematuria, edema, 1-2 weeks after acute pharyngitis in kid

Answer 11

post-strep GN, hypertension

Question 12

SW US region pneumonia infection with skin findings

Answer 12

Coccidioidomycosis is a common infection in the southwestern United States. In addition to the symptoms in this patient, coccidioidomycosis can also present with a rash such as erythema nodosum.

Question 13

What antibiotic tx should be avoided in a patient with abdominal aneurysm?

Answer 13

The FDA issued a warning that systemic fluoroquinolones can increase the occurrence of aortic dissections or ruptures. Drugs in this group should be avoided in patients with an existing aortic aneurysm or in patients at increased risk for developing an aortic aneurysm unless there are no other treatment options available.

Question 14

What is a common practice with patients with chronic adrenal insuffiency amidst an infectino?

Answer 14

Common practice during minor infections is to increase the corticosteroid supplementation (SOR C). Fludrocortisone should be continued, but stress dosing is not necessary.

Otherwise thought that they cant mount stress response to infection

Question 15

what is the best tx for a thrombosed external hemorrohoid?

Answer 15

Office-based surgical excision of the thrombosed external hemorrhoid within 2–3 days of symptom onset may provide significant symptomatic relief (SOR B) and result in a lower risk of recurrence. While conservative treatment with topical therapies such as corticosteroids may be helpful, symptomatic relief is prolonged with excision of the thrombosed hemorrhoid.

Question 16

when should a kiddos’ hemoglobin be checked for anemia?

Answer 16

at 12 months age

Multiple reports have associated iron deficiency with impaired neurodevelopment and it is therefore essential to ensure adequate iron intake. Based on expert opinion, the American Academy of Pediatrics recommends measuring a child’s hemoglobin level at 12 months of age.

Question 17

What is the treatment for early lyme disease with symptoms of rash, joint paint/muscle pain, fevers?

Answer 17

doxycycline 7-21 days

Question 18

what do you give to prevent lyme symptoms in patient found to have tick removed?

Answer 18

doxycycline x1

Question 19

What is the treatment of mild croup? severe croup?

Answer 19

single dose of dex for mild; severe croup - gets nebulized racemic epi in hospital setting

Question 20

What is the treatment for Takatsubo CM?

Answer 20

Once symptoms and cardiac abnormalities resolve, treatment is no longer indicated and may be withdrawn if there are no signs of coronary disease. Because this patient currently has cardiomyopathic abnormalities, a diuretic, ACE inhibitor, and -blocker are indicated.

Question 21

tx for acute rheumatic fever?

Answer 21

Once the diagnosis of acute rheumatic fever is made, NSAIDs such as aspirin or naproxen should be administered (SOR B). The therapeutic response to NSAIDs is often remarkable.

Question 22

initiating fluoride at what age and how often in kiddos?

Answer 22

Twice-yearly application of fluoride varnish to primary teeth should begin when the first tooth comes in and repeated every 6 months thereafter in children (SOR B).

prevention of dental caries

Question 23

What newborns get ultrasounds for infants for developmental dysplasia of the hip?

Answer 23

targeted screening ultrasonography for infants who were breech in the third trimester, have a family history of DDH, or have a personal history of instability.

uncertain benefit so controversial

Question 24

what are risk factor for recurrent seizures that should lead to AED treatment? there are atleast 5

Answer 24

1) two unprovoked seizures more than 24 hours apart,
2) epileptiform abnormalities on an EEG,
3) abnormal brain imaging results,
4) severe head trauma,
5) and a syndrome associated with epilepsy.

In children who do not have any of these risk factors, antiepileptic drug therapy is not indicated after a first unprovoked seizure.

Question 25

What should be used to treat pleuritic pain?

Answer 25

NSAIDs are fine!

Question 26

Which tx has the best evidence for delaying the need for definitive surgical therapy for carpal tunnel syndrome?

Answer 26

steroid injection!

Question 27

mgmt of acute urinary retention?

Answer 27

Acute symptomatic urinary retention should be treated with immediate urethral catheterization. The catheter should be left in place for 3 days, followed by a voiding trial.

Question 28

IBS - what is the basic definition? Two parts to it.

Answer 28

1) recurrent abdominal pain at least 1 day per week for at least 3 months.
2) At least two of the following must be present: abdominal pain related to defecation, a change in stool form, and/or a change in stool frequency.

Question 29

What are dental concerns that are important to consider for pregnancy?

Answer 29

the risk of dental caries, loose teeth, gingivitis, and periodontitis all increase during pregnancy.

1) Pregnant women are at higher risk for dental caries because the oral cavity is exposed to more gastric acidity due to vomiting with morning sickness, and acid reflux due to a lax esophageal sphincter and upward pressure from a gravid uterus.
2) Increased levels of estrogen and progesterone during pregnancy can relax the ligaments and bones that support the teeth, leading to a temporary loosening of teeth.

Gingivitis and periodontitis increase during pregnancy because of a fluctuation in estrogen and progesterone levels in combination with changes in oral flora and a decreased immune response. Periodontitis is of particular concern during pregnancy and should be treated because of its association with preterm birth and low birth weights.

Question 30

what are two common meds that are culprits for hypoNa?

Answer 30

SSRIs and thiazide diuretics

Question 31

what electorlyte abnormalities can appear abnormally normal in DKA?

Answer 31

A low serum potassium level in diabetic ketoacidosis (DKA) indicates a significant potassium deficiency, placing the patient at risk for a cardiac arrhythmia, among other complications. Potassium deficiency is usually the product of urinary losses due to glucose osmotic diuresis and secondary hyperaldosteronism. However, serum potassium can remain normal when there is a whole body deficiency, as a result of movement of potassium out of cells in response to the acidosis, insulin deficiency, and hyperosmolality. This patient’s serum potassium is low, which indicates severe deficiency.

Question 32

Who should get prophylaxis against measles if exposed?

Answer 32

To be effective as postexposure prophylaxis the vaccine must be administered within 72 hours of exposure.
Infants <12 months of age are considered to be at high risk for complications from measles and should receive postexposure MMR vaccine, although intramuscular immunoglobulin is also an option. Children who are otherwise fully vaccinated do not need additional prophylaxis.

Question 33

How should children and adolescents with celiac disease be monitored? What serology should one get?

Answer 33

The World Gastroenterology Organisation recommends annual monitoring of children and adolescents with celiac disease by anthropometry, pubertal development, and celiac serology. The preferred serology is IgA antibody to tissue transglutaminase (IgA anti-tTG) due to its balance of good performance and low cost. Failure of IgA anti-tTG titers to decrease in 6 months suggests continued ingestion of gluten. Repeat duodenoscopy with a biopsy would be unnecessary and would subject the child to potential harm.

Question 34

How to treat a heatstroke? How is it defined?

Answer 34

A core temperature >40°C (104°F) is consistent with heatstroke. In treating patients with either clinical variant of heatstroke, cold or ice-water immersion is the most effective treatment and should be initiated as soon as possible, without delaying for transfer to the hospital setting (SOR A).

Question 35

What are the four Kanavel’s signs and what is the diagnosis?

Answer 35

pyogenic flexor tenosynovitis - infection of the tendon sheath; pain with passive extension, tenderness with palpation of the tendon sheath, flexed position of the involved finger, and fusiform swelling of the finger.

Question 36

What is first line treatment for acne?

Answer 36

benzoyl peroxide with retinoid

Topical retinoids are first-line treatment for any level of severity of acne (SOR A). Adapalene is an effective retinoid and is available over-the-counter. Benzoyl peroxide is also very effective in the control of acne because it reduces the concentration of cystic acne with no risk of bacterial resistance

Question 37

Distribution of hair loss in men vs women

Answer 37

Androgenetic alopecia is associated with bitemporal thinning of the frontal and vertex scalp in men, but in women the frontal hairline is spared and hair thinning is most apparent at the vertex. There is often a family history of hair loss in patients with androgenetic alopecia

Question 38

best mgmt of ankle sprain

Answer 38

Early mobilization leads to better outcomes with ankle sprains, and using a functional ankle brace such as a semi-rigid air stirrup brace or a soft lace-up ankle brace will protect the ankle from inversion and eversion sprains while still allowing for mobility during physical activity. T

Question 39

what diuretic can cause hyperCa?

Answer 39

HCTZ

Question 40

What diseases are patients with Turner Syndrome more prone to?

Answer 40

Turner syndrome is associated with higher risks of endometrial cancer, celiac disease, and structural heart defects.

Question 41

What kind of tx should be offered to an adolescent interested in gender conversion?

Answer 41

Hormonal intervention therapy should not be offered prior to puberty. However, stage 2 or 3 of sexual maturity is an appropriate time to consider gonadotropin-releasing hormone analogue therapy (SOR B). Individuals who receive hormone therapy often report less anxiety, increased self-esteem, and better quality of life (SOR A)

Question 42

what is tx for flaccid bullae in the intertriginous area?

Answer 42

Bullous impetigo is caused by Staphylococcus aureus, which produces a toxin responsible for flaccid bullae and is more likely to affect the intertriginous areas. This usually resolves within 3 weeks without scarring. Impetigo, either bullous or nonbullous, may be treated with topical antibiotics such as mupirocin. Because of emerging drug resistance, oral azithromycin and other macrolides should not be used.

Question 43

Common dx for knee pain in active adolescnets?

Answer 43

. Osteochondrosis is a more general term for this condition, which can occur at growth plates around other joints, including the hip, foot, elbow, and back. In Osgood-Schlatter disease repetitive traction of the patellar tendon on the tibial tubercle ossification center leads to inflammation and pain. Imaging is not required to make the diagnosis when patients present with typical symptoms and physical examination findings. Radiographs may be obtained if there is uncertainty about the diagnosis. Radiographic findings in Osgood-Schlatter disease include soft-tissue swelling and fragmentation of the tibial tubercle.

Question 44

recurrent right foot swelling and redness mistaken for cellulitis? no infectious data. waht’s a potential dx if pt has peripheral neuropathy?

Answer 44

Charcot neuropathy

can start with radiography, but MRI definitive

Question 45

what is tx for Charcot neuropathy?

Answer 45

acute Charcot neuroarthropathy is immobilization with total contact casting, which increases the total surface area of contact to the entire lower extremity, distributing pressure away from the foot. Immobilization is typically required for at least 3–4 months but in some cases may be needed for up to 12 months. Bisphosphonates were found to be ineffective as adjunctive therapy in acute Charcot neuroarthropathy. Corticosteroids and antibiotics have no role in the treatment of Charcot foot but would be appropriate therapy for cellul

Question 46

what defines asthma on spirometry?

Answer 46

A methacholine challenge is recommended in this scenario to assess for the airway hyperresponsiveness that is the hallmark of asthma. Methacholine is a cholinergic agonist. Bronchoconstriction (defined as a reduction in FEV1 􏰀20%) observed at low levels of methacholine administration (<4 mg/mL) is consistent with asthma.

Question 47

what are the glucose goals in GDM?

Answer 47

fasting less than 95, 1hr pp 140, 2 hr pp 120

Question 48

for an MI what are two classes of immediate treatments?

Answer 48

antiplatelet treatment with aspirin/plavix

anticoagulation with heparin gtt

Question 49

how is severity of alcohol use classified? what is severe?

Answer 49

Mild alcohol use disorder is defined by the presence of 2–3 of the 11 symptoms documented in the DSM-5, whereas 3–5 symptoms indicate moderate alcohol use disorder and 6 or more symptoms indicate severe alcohol use disorder.

Question 50

purpura of lower ext w.o low plt or coagulopathy

what is dx in kids?

Answer 50

Henoch-Schönlein purpura is an IgA vasculitis that is usually diagnosed clinically. It presents as palpable purpura of the lower extremities without thrombocytopenia or coagulopathy. It is often associated with arthralgias and arthritis, abdominal pain, and renal dysfunction. It is self-limited and treatment is supportive only.

Question 51

Indicators of pancreatitis severity - what are they? name 3

Answer 51

Hematocrit, BUN, and creatinine levels

NOT lipase

Question 52

can you use a1c to assess DM in sickle cell?

Answer 52

no. Hemoglobinopathies falsely lower hemoglobin A1c as a result of hemolysis and abnormal glycation. Fructosamine correlates well with hemoglobin A1c levels and is recommended instead of hemoglobin A1c for monitoring glucose control in patients with diabetes and hemoglobinopathies. A

Question 53

does topirimate raise risk of renal stones?

Answer 53

YES carbonic anhydrase inhibitor, which induces a metabolic acidosis that leads to hypercalciuria and the formation of calcium phosphate stones.

Question 54

HPV dosing schedule before 15 and after 15 intiiation

Answer 54

Starts at 11. Children who receive the first dose of the vaccine before the age of 15 and receive two doses are considered adequately vaccinated. If the first dose is given after age 15, a three-dose series is recommended.

Question 55

lenght of DVT treatment in provoked DVT

Answer 55

The risk for VTE recurrence is dependent on patient factors, such as active cancers and thrombophilia. Current guidelines recommend treatment for at least 3 months.

Question 56

primary focal hyperhidrosis - what is tx?

Answer 56

recommended first-line treatment for is topical 20% aluminum chloride.

Question 57

what happens to TSH in pregnancy?

Answer 57

they go down! because hcg cross reacts with TSH and feedsback to lower TSH

Question 58

indications for radiography for knee pain according to Ottawa rules

Answer 58

• inability to take four or more steps immediately after an injury or in the emergency setting is an indication for radiography in all three rules.
• Age is an indication for radiography in acute knee pain in patients over 55 years of age according to the Ottawa rule, or under 12 or over 50 years of age according to the Pittsburgh rule. The patient’s sex does not factor into the criteria for imaging.
• Bony tenderness is an indication for imaging according to the ACR and Ottawa rules, but only if isolated over the proximal fibula or over the patella without other bony tenderness.

Question 59

what size stones can tamsulosin help pass?

Answer 59

5mm to 10mm

Question 60

what tx in addition to abx can help with severe community-acquired pneumonia based on clinical criteria, including an elevated respiratory rate, confusion, and hypotension requiring aggressive fluid resuscitation

Answer 60

IV steroids like methylpred

Question 61

what can help with frailty?

Answer 61

The current literature supports resistance training to improve physical function before aerobic exercise is introduced. Although there was hope that nutritional counseling would improve outcomes, it does not seem to have an effect.

Question 62

what is the course of postpartum thyroiditis?

Answer 62

• Postpartum thyroiditis is defined as a transient or persistent thyroid dysfunction that occurs within 1 year of childbirth, miscarriage, or medical abortion.
• hyperthyroid, than hypothyroid: Release of preformed thyroid hormone in the bloodstream initially results in hyperthyroidism. During the hyperthyroid phase, radioactive iodine uptake will be low, which can help to confirm the diagnosis.

Question 63

what is the preferred imaging modality for calcaneal stress fx?

Answer 63

MRI

calcaneal stress fracture as suggested by the history of increased running on a hard surface, improvement with rest, and a positive calcaneal squeeze on examination. A delay in diagnosis increases the risk of delayed union. MRI is the preferred imaging modality because radiographs often do not detect a calcaneal stress fracture.

Question 64

Koilonychia, also known as spoon nail, is a finding that can be associated with …..

Answer 64

Fe def, hypothyroidism, SLE

Question 65

three criteria for PCOS? of which you need 2.

Answer 65

hyperandrogenism, ovulatory dysfunction, and at least one polycystic ovary.

Question 66

where does the pain from Osgood Schlatter in kids come from in the knee?

Answer 66

In Osgood-Schlatter disease repetitive traction of the patellar tendon on the tibial tubercle ossification center leads to inflammation and pain. Imaging is not required to make the diagnosis when patients present with typical symptoms and physical examination findings. Radiographs may be obtained if there is uncertainty about the diagnosis. Radiographic findings in Osgood-Schlatter disease include soft-tissue swelling and fragmentation of the tibial tubercle.

Question 67

most common cause sof chronic cough?

Answer 67

chronic cough in adults include upper airway cough syndrome, tobacco use, GERD, asthma, and ACE inhibitor use.

Question 68

what is a common drug that can cause drug induced hyperCa?

Answer 68

Hydrochlorothiazide can cause drug-induced hypercalcemia. Alendronate

Question 69

assessment of decreased libido in males

Answer 69

In men who are diagnosed with hypogonadism with symptoms of testosterone deficiency and unequivocally and consistently low serum testosterone concentrations, further evaluation with FSH and LH levels is advised as the initial workup to distinguish between primary and secondary hypogonadism.

Question 70

what is treatment of Dupytren’s contracture?

Answer 70

Dupuytren’s disease with a contracture of the affected finger. Surgical release is indicated when the metacarpophalangeal joint contracture reaches 30° or with any degree of contracture of the proximal interphalangeal joint.