Primary Care

Question 1

When is the greatest loss on bone mineral density?

Answer 1

The first 2 years after menopause

Question 2

Osteoporosis is defined as…?

Answer 2

A T score below -2.5

Question 3

Etiology of osteoporosis?

Answer 3

Tx with glucocorticosteroids, Vit D deficiency, thyroid replacement therapy, active peptic ulcer disease, abnormal kidney and liver function, malabsorption syndromes and estrogen loss.

Question 4

What is Cholecystitis?

Answer 4

Inflammation of the gall bladder.

Question 5

What is Cholelithiasis?

Answer 5

Obstruction of the gall bladder.

Question 6

Signs and Symptoms of Cholelithiasis and Cholecystitis?

Answer 6

RUQ and epigastric pain radiating to upper back and intolerance of fatty foods. Pain can be intermittent or constant. Jaundice = Cholelithiasis. Abdominal pain and fever = Cholecystitis.

Question 7

What is the diagnosis of Chole (both)?

Answer 7

Positive Murphy’s Sign: curl fingers under rib cage over liver and ask pt to exhale. Postivie if inspiration is interrupted or whencing is noticed.

Question 8

Tx for Chole (both)

Answer 8

Drugs may dissolve stones, cholecystectomy may be preferred. For acute disease refer to surgeon.

Question 9

Non-pharm management of osteoperosis

Answer 9

Midwife will consult. Diet with protein, vit D and Calcium. Weight bearing exercise, i.e. walking 30 min 3xs per wk

Question 10

Pharm management of Osteoporosis

Answer 10

Fossamax (bisphosphonate) PO q weekly or Boniva q monthly. Reloxifene (SERM). HRT and Vit D - 800IU + 1200mg Calcium. (Thiazide diuretics for HTN may decrease bone loss by reducing urinary excretion or calcium.

Question 11

MOA of Fossamax (bisphosphate)

Answer 11

Decrease Bone turnover, inhibit resorption, increase formation of bone

Question 12

MOA of Reloxifine (SERM)

Answer 12

acts like Estrogen on bone and heart, but not on breast and uterus, improves bone, lipid profile by decreasing LDL, but has no effect on HDL

Question 13

Dx for Type 2 DM

Answer 13

Fasting > or = 126, random or 2hr 75mg glucola challenge 200 or over; HcbA1C >6.5%

Question 14

S/S Pyleonephritis (UTI)

Answer 14

low grade fever, chills, dysuria, flank pain (CVAT) usually on right side 50%, 25% bilateral.

Question 15

Tx for acute Pyleonephritis

Answer 15

Bactim 160/800mg PO BID 14 days or Cephlosporin (Keflex) 250-500mg PO QID
Consult with pyleo

Question 16

Genotype is defined as

Answer 16

Combination of genetic factors in an individual

Question 17

Prolonged untreated GERD can cause

Answer 17

Barrett’s esophagus

Question 18

A 40 year old woman comes in for her annual exam. Her BP is 138/85. You recognize this as:

Answer 18

Prehypertension and suggest lifestyle modifications

Question 19

Patient comes into the office after stepping on a rusty nail. she inquires about the tetanus vaccine. had a full series and received last booster about 9 years ago. You advise her to

Answer 19

Be revaccinated with a booster as this is an unclean wound and her adult booster was more than 5 years ago.

Question 20

The varicella immunization is only contraindicated in what 2 groups

Answer 20

Pregnancy and HIV infections

Question 21

Osteopenia is defined as a T-score between

Answer 21

-1.0 and -2.5

Question 22

Recommended daily calcium intake for women 19-50 years old

Answer 22

1000 mg

Question 23

A component of the physical exam that suggests metabolic syndrome

Answer 23

waist circumference >40inches in men or >35 inches in women

Question 24

Most common type of skin cancer in America is

Answer 24

Basal cell carcinoma

Question 25

Daycare worker comes in with honey crusted lesions on her arm. She said that she gotten some mosquito bites. You recognize these lesions as

Answer 25

Impetigo

Question 26

19 y/o female, has annular lesions with a raised border on her trunk, mildly pruritic. Skin scraping viewed with KOH under the microscope shows hyphae. What is it

Answer 26

Tinea corporis

Question 27

An afebrile 25 y/o female returns from a beach holidday with complaints of left ear pain of 24hrs. The pinna is exquisitely tender with traction. The pt has what

Answer 27

Otitis externa

Question 28

A normal weight is defined as a BMI of

Answer 28

18.5-24

Question 29

A major goal in the treatment of asthma is to reduce the incidence of

Answer 29

Inflammation

Question 30

a non-pregnant female with uncomplicated cystitis, preferred length of antibiotic treatment

Answer 30

3 days

Question 31

Recurrent UTI is defined as how many episodes

Answer 31

at least 3 per year

Question 32

A 50 yr old overweight female has a blood pressure of 120/90 on routine screening. would you diagnose as HTN

Answer 32

To diagnose HTN she should have 2 BP checks on 2 separate occasions.

Question 33

52 y/o obese smoker with BP consistantly ranging from 150-160/90-96. What meds would you recommend

Answer 33

Thiazide diuretics

Question 34

Asthma symptoms that occur more than twice/week with exacerbations that may affect activity classified as

Answer 34

Mild persistant

Question 35

Headaches that present as severe unilateral, orbital, supraorbital, or temporal pain in nature

Answer 35

Cluster headaches

Question 36

HGBa1C >= to 6.5% is diagnostic for

Answer 36

Type II DM

Question 37

The single best test to evaluate for hypothyroidism proceeded by thyroid glad failure

Answer 37

TSH

Question 38

Fasting glucose of 100-125 or glucose levels of 140-199 at 2 hrs pp indicate what

Answer 38

pre diabetes

Question 39

RBCs that are hypochromic and microcytic show increased total iron binding capacity and decreased serum iron suggest what

Answer 39

Iron deficiency anemia

Question 40

LDL > 160 and an associated risk factor for CHD is counseled to begin an appropriate trial fo dietary therapy. When to reevaluate

Answer 40

3 months

Question 41

An active 25 y/o presents with an 8cm oval shaped area of erythema that blanches with pressure, does not deesdquamate, vesiculate, or have any scale at periphery. They appeared 2 weeks following a camping trip. You suspect

Answer 41

Lyme Disease

Question 42

Initial and most important step in the managment of GERD is

Answer 42

Lifestyle modification

Question 43

Form of hepatitis is the only acute from, never results in a chronic disease and lifelong immunity is expected from all patients who recover from it

Answer 43

Hep C

Question 44

Single most important action you can take with a patient you suspect is the victim of intimate partner violence is what

Answer 44

Help develop a safe exit plan

Question 45

When a pt presents with persistent diarrhea following 2 courses of abx you should suspect

Answer 45

C. Diff