Q Bank 2 Flashcards
(251 cards)
1
Q
Tx for upper airway cough syndrome
A
Decongestant
po or IN antihistamine
IN corticosteroid
Saline rinses
PE fingins - swollen turbinates and posterior pharyngeal cobblestoneing
Refer to allergy if no improvement after 2 months
2
Q
If you suspect a bicep tendon tear what do you do next?
A
Get an MRI
PT isn’t going to be helpful
3
Q
At what HA1C level do you need to add a second agent?
A
> 9%
4
Q
Time to peak effect of po opioids?
A
1 hour
IV reaches peak in 10 minutes
5
Q
What is the only tx that reduces mortality in pHTN related to COPD?
A
Supplemental O2
6
Q
What anti HTN meds lessen severity of OSA?
A
Diuretics, especially spironolactone d/t aldosterone effect
7
Q
What test is most specific for fibromuscular dysplasia?
A
MRA of the renal arteries
OR CT Angio
8
Q
Greatest risk factor for developing OA?
A
Obesity
9
Q
Tx for exercise induces asthma?
A
SABA 15 min before their run
10
Q
Pt has pain anterior to L ear extending to mandible. VSS. L parotid is diffusely enlarged, tender and purulent material is coming from the L parotid duct orifice. tx?
A
Augmentin
Dx - acute parotitis
caused by dehydration
can also try lemon drops and parotid gland massage
11
Q
What is an absolute contraindication for testosterone therapy
A
PolycytemaHCT > 54% Breast cancer prostate cancer PSA > 4 ABN rectal exam w/ nodule
12
Q
Most effective medication to help maintain alcohol abstinence?
A
Acamprosate
13
Q
Common cardiac anomaly in Marfan’s?
A
Aortic insufficiency
14
Q
40 + Pt with 30 pyr smoking history has “quarter size” hemoptysis. Now what?
A
CT chest
15
Q
Football player has pain limiting practice at proximal 5th metatarsal, Xray negative. Now what?
A
Order MRI of foot
If + get a hard shoe x 3 weeks with progressive activity and NSAIDs as tolerated
16
Q
If you want to start an atypical antipsychotic on a dementia pt, what do you tell family regarding side effects?
A
Risk of mortality is increased
17
Q
Which type of T2DM meds are likely to cause weight gain?
A
Sulfonylures (glimepiride)
18
Q
Teen M Tanner 3 has a lump on L chest under areola. No nipple discharge or adenopathy. Next?
A
Follow up in 6-12 months Adolescent physiologic gynecomastia Normal in up to half of M teens Resolves in 6-24 months Be concerns if: present >2 years, hard/immobile/nontender, >5cm, nipple discharge, testicular mass, weight loss
19
Q
Man has itchy rash around nasolabials and mustache. Tx and Dx?
A
Seborrheic dermatitis
Erythematous patches with white/yellow greasy scales
Tx - TOP anti fungal
20
Q
Next step for peripartum depression?
A
Refer for therapy
Peripartum blues lasts <10 days
21
Q
1st line Tx for RA?
A
Methotrexate
22
Q
You want to start a statin on a pt planning to undergo planned TKR in 6 months. How do you counsel?
A
Start now to decrease risk of CV did and preoperative mortality
23
Q
Male, just quit smoking has microscopic hematuria on UA>. What does he need next?
A
Cystoscopy
Indicated if pt > 35
24
Q
1st line Tx for T2DM?
A
Metformin
25
Pt has allergies 5-7 days/wk x 6 months despite Allegra. Next tx?
```
IN budesonide (Rhinocort)
Pt has persistent allergic rhinitis (syx >4 days x > 4weeks)
```
26
Tx for a venous stasis ulcer?
Compression Therapy
27
Cut off GFR for Gadolinium in MRI?
<30
28
Most important factors to prevent Post party hemorrhage?
Active management of 3rd stage of labor
| Giving oxytocin after delivery of anterior shoulder
29
During a code you see Vtach. What do you do?
Defibrillation
| If unsuccessful give episodes and def again
30
In pts with COPD which INH have been shown to reduce exacerbation and exacerbation related hospitalizations?
Tiotropium (Spiriva)
| Beter than LABA (Salmetrerol)
31
Otherwise healthy patient has mildly elevated LFTS with negative viral hep panel. LFTs elevated on 2 occasions. Next?
US and ferritin
| r/o hemochromatosis before working up FLD
32
Best way to determine if a pt is safe to take metformin?
eGFR
33
Initial Tx for Sarcoid
Prednisone
34
Pt has depression syx present x several years but is worse around menses, but present all throughout the month. Dx?
Dysthymia
| In premenstrual dysmorphic disorder syx would only be present around menses
35
M pt has rash on neck where beard is x 1 year. Exam - curly facial hair, slightly tender, red hyperpigmented papules. Dx and Tx
pseudofolliculitis barbae - more common in folks with curly hair. Hairs are cute an an angle and curl in on themselves creating a foreign body rxn
Tx - electric clippers or to stop shaving
36
Teenager with athletes triad (BMI 16) and amenorrhea, what studies do you need?
BhCG
FSH/LH
TSH
DEXA
37
DVT Tx in pregnancy?
SQ Lovenox
| Warfarin and DOACs have not been studied in pregnancy
38
PCOS patient has hyperpigmented patches along mandible. Dx and what med is causing it?
Melasma
| Associated with pregnancy, OCPs, anticonvulsants
39
Medications that improve mortality in HFrEF
ACEI
Bblck
ARBs
Aldosterone antagonists (Spironolactone)
40
Pt with active cancer has a new PE. What are they d/c'd on?
Lovenox
| DOACs haven't been studied in malignancy
41
Pt on Warfarin for afib is planning to undergo surgery. How do you manage warfarin?
Stop 5 days prior to surgery and restart 12-24h post operatively unless there is a complication
42
Pt has dysphagia to solids but not liquids. Next?
EGD
| C/f structural lesion
43
Pt with CAP was d/c'd on supplemental O2. Home health aid trialed pt off O2 x 1 hour and Sat >90%. What do you do?
d/c supplemental O2
No real benefit once they are over 88%
keeping pt on O2 too long increases risk of falls, fires, mucosal irritation
44
PCOS treatment associated with great live birth and ovulation rates
Letrozole (Femara)
| Beter than clomiphene
45
Pt has sudden onset of multiple well circumscribed brown, oval, rough papule with "stuck on appearance" weight loss, pallor. What is on ddx and what to do next?
Sudden appearance of multiple seborrheic keratoses concerning for underlying malignancy - most common is adenocarcinoma of the stomach
Needs EGD and c-scope
NOT skin bx
46
Tx for Rocky Mountain spotted fever
Doxycycline
| Start ASAP to decrease mortality
47
What T2DM medications are you hesitant with in a pt with hx of pancreatitis?
DPP-4 Inhibitor (Sitagliptin (Januvia))
| GLP-1 agonist (Liraglutide (Victoza))
48
What co-morbidity can falsely lower the HA1C in a T2DM pt
Hemolytic anemia
| Not Asplenia, IDA, CKD, Bit B12 deficiency - increases HA1C d/t increased longevity of RBC
49
Syx of Lithium toxicity
Often triggered by an inciting event (volume depletion, change in renal fxn)
Syx - GI upset, arrhythmia, CNS changes (tremor, confusion, agitation)
Usually a chronic toxicity seen in elderly patients d/t low muscle mass and decreased GFR. Usually follows an illness
50
How many days of abx should a routine CAP receive?
5 days. No benefit of longer courses
51
Asthmatic poorly controlled on Albuterol. Next step?
Fluticasone/salmeterol (Advair)
| ICS/LABA
52
2 most common etiologies of neonatal sepsis?
1st - Group B Strep
2nd - E coli
Listeria is pretty uncommon now. Staph aureus and Group A strep are possible, but less likely. Strep pneumonia does not cause neonatal sepsis
53
Pt is bothered b tinnitus. What else should you check for?
Sensorineural hearing loss
| Most tinnitus is idiopathic, but it is also associated with hearing loss
54
Penile lesions x 6 months, reddish-blue papule on the scrotom with a few similar lesions on the shaft. Dx?
Angiokeratomas
No tx needed unless bleeding
If present on shaft, suprapubic region or sacrum could be associated w/ Fabry dz and should be referred
55
Penile lesion - small skin colored dome shaped populates in circular pattern around coronal sulcus
Pearly penile papules
| Benigns
56
Penile lesion - discrete pinhead-sized hypopigmented papule, asymptomatic. Can be scattered over penis and abdomen/legs
Lichen nitidus
| Benign
57
Penile lesion - hypopigmented lesion with the texture of cellophane, usually on glans or prepuce. Atrophy, erosions, bull are common.
Lichen sclerosus - can be associated with SCC
58
Uncircumscrised M over 60 y/o - penile lesion beefy red, raised, irregular plaques on the glans, meatus, frenulum, coronal sulcus, prepuce. Can be ulcerated or crusted. Pain, itch common
squamous cell Carcinoma in situ (need Bx)
59
Pt hs 10 yr hx of HA QD. b/l with pressure/tightening quality w/o phono or photophobia. tend to worsen as day progresses. dx and tx?
chronic tension type HA
| Amitriptyline can reduce HA duration and severity
60
1st line tx of diabetic neuropathy
Pregabalin (Lyrica) or gabapentin
61
F pt with hair loss, has a smooth circular area of complete hair loss on scalp w/o skin changes. Tx?
Intralesional corticosteroids
Dx - alopecia areata - chronic relapsing immune mediated inflammatory disorder affecting hair follicles causing patchy hair loss
IF over 50% of scalp is involved can use TOP immunotherapy
TOP steroid is only used in kids or adults that can't handle the injection
62
What's the formula for fluids in sepsis?
30mL/kg in first 3 hours in 500mL boluses
| Lactate >3.6 suggests severe dz even if BP is ok
63
When do women need breast MRIs
Women at very high risk of breast cancer
| ie - known genetic mutations, history of breast irradiation, high risk FHx, chest radiation (ie for Hodgkin's dz)
64
Bball player has pain and flexion deformity in DIP joint. What wouldn't make you want more of a work up before splinting?
Pt is unable to passively fully extend the joint
Hallmark of mallet finger is that pt can't actively extending DIP joint.
However, inability to passively extend the DIP joint suggests trapped soft tissue or bone that may require surgery
IF > 30% avulsion needs ortho referral
Tx - splint with strict avoidance of keeping DIP joint in flexion even if delayed presentation. Can do activities even with splint in place
65
Pt under 65 needing both PCV 13 and PPSV23?
Chronic renal failure
66
Pt Under 65 needing just PPSV23
```
Chronic lung dz
T2DM
heart disease
smoking
EtOH abuse
```
67
Sudden facial droop, unable to furrow brow on that side. Tx?
Valacyclovir and tapering dose of steroid
Dx - Bell's palsy
Antiviral + steroid more effective than steroid alone and if started within 72h of onset
68
Test to dx Cushing syndrome
24h urinary cortisol
| NOT dexamethasone depression
69
Obese smoker with NL FEV/FVC ratio but Bicarb is 35. Dx?
Obesity-hypoventilation syndrome
| Restrictive on spirometry
70
What is a complication of having an over treated hypothyroid with TSH <0.1
Increased risk of hip and vertebral fx
71
young pt with weight loss, oral thrush, lymphadenopathy, ulcerative esophagitis, c/f?
HIV
72
Dx and tx of honey crusted lesions on a kiddo?
Impetigo
| TOP mupirocin
73
31 wk GA preggo is given tocolytics and betamethasone and d/c'd 2 days later with stable cervical exam. Returns 2 weeks later with contractions and unchanged exam. Now what?
Expectant management. Goal of tocolytics prior to 34 weeks is to allow betamethasone time to work
No benefit in tocolytic for one more week
74
Trigger points in fibromyalgia?
Medial scapula borders, posterior neck, upper outer quadrants of the gluteal muscles, medial fat pads of knees
75
1st line CAP tx for output of young adult
Azithromycin
76
RF for intermittent claudication
T2DM
Smoking
HTN
dyslipidemia
77
A singer has had hoarseness x 10 days, she wants to sing again as soon as possible
No talking whispering, throat clearing for 48 hours
78
when would you get labs on a kiddo with acne
acne in mid childhood (>1 yr to 8 y/o)
79
Start ASA at what ACSVD cut off
10%
80
Hallmarks of baby friendly hospital
```
Counsel on breast feeding, esp w/in 1 hour of birth
No other fluids or foods
Roomin in
BF on demand
No pacifiers
```
81
Tx for pituitary adenoma
<10 mm --> bromocriptine
| > 10 mm --> surgery
82
Tx for acute bronchitis
Sudafed, honey, guaifenesin
83
which patients need abx before dental procedures?
prosthetic heart valves
Previous dx of endocarditis
unprepared cyanotic congenital heart disease (or repaired with residual shunt), heart transplant w/ regurgitation
Tx - Amoxicillin 2g once
84
type of therapy that works for OCD
CBT
85
At what age do you consider life expectancy when referring for screening c-scope
75
86
18 m/o WCC not meeting gross motor milestones. What would suggest MD?
Head lag when sitting up
| Think syx d/t muscle weakness. Anything that suggests increased tone or hyperrreflexia is more c/w CP
87
Oligohydramnios is associated with what fetal anomalies?
Oliguria or anuria (renal genesis, obstruction from posterior urethral valves)
88
What abx combo would cover strep pyogenes and MRSA in a cellulitis?
Bactrim (MRSA) + keflex (Strep)
| OR Clinda
89
At what age does a lazy eye become abnormal?
6 m/o - refer to ophtho
| prior to 6 m it can be d/t imperfect coordination
90
most successful way to prevent travelers diarrhea?
Washing hands frequently or hand sanitizer
| Avoiding street meat, tap water, ice, raw foods has not been shown to reduce risk
91
30 y/o G2P2 with amenorrhea, hot flashes, vaginal dryness x 1 year. Preg neg, NL TSH, prolactin. Elevated LH/FSH. Dx?
Primary Ovarian Insufficiency
| Definition - menopause before age 40 d/t ovarian follicular depletion. Low estradiol, high FSH/LH
92
Most common cause of hypercalcemia?
hyperParathyroid
93
When do you think about doing NG feeds in a bronchiolitis?
RR >60, too hard to tolerate feeds
94
All pt handouts should be writing to what level?
5th grade
95
Pt is on chronic oxygen for knee OA. Refuses NSAID and PT. What do you do?
Taper oxycodone by 5-10% every 1-4 weeks
96
Teen football player has R shoulder pain d/t lots of throwing practice. Pain when raising hand above shoulder, +TTP proximal and lateral humerus. Dx and work up?
Little league shoulder (disruption at the growth plate of the humerus)
Get XRAY - look for widening, demineralization, or sclerosis at the growth plate.
If Nl Xray but suspicion still high get bone scan or MRI
97
sudden onset of pain and redness in eye, sluggish pupil reaction, decreased visual acuity
emergent referal to ophthalmology
| c/f acute angle closure glaucoma
98
3 y/o turns toes in when he walks and has a clumsy gait. On exam feet point inward but patellae face forward. Dx and management?
Internal tibial torsion
No intervention, resolves spontaneously by age 5
May consider surgery if present at age 8 if symptomatic
no splints or shoe changes
99
62 y/o healthy female in rural NM has intractable n/v, hypotension after cleaning out a chicken coop and being exposed to rodents. blood Cx grow GNRs. Most likely pathogen?
Yersinia pestis
| Kinda a dumb answer..
100
Human infection associated with contact of infected sheep, cattle, goats, dogs, cats
Coxiella burnetii
Gram neg
Q fevere
101
Human infection associated with contact of tissue rich in erythritol and fluids from goats and sheep
Brucella melitensis
| Gram negative coccobacilli
102
24 AA M cough x weeks, b/l facial n. palsy. NL CBC and UA. CXR w/ b/l LN enlargement. Dx?
Sarcoidosis
b/l FN palsy in <5% of cases
Can have hemoptysis d/t aspergillus infection/cavitation
Rare renal involvement
103
Take what OTC supplement is associated with serious intracerebral bleeding if take with AC
Ginko biloba
104
Which NSAID is safest to use in pt w/ h/o MI?
Naproxen
105
Where is a tracheostomy inserted?
Cricothyroid membrane
Directly ABOVE the cricoid cartilage
lies below the larynx
106
problem with having a RBB + L anterior hemiblock on EKG?
Trifascicular block puts pt at risk of tachyarrhythmias and bradyarrhythmias
if symptomatic, Needs cardiac monitoring to decide if pacemaker is needed
107
Why do we do a 2 step PPD?
If second step is positive demonstrates that pt has long standing latent TB
108
shoulder exam: forward flex am to 90 with elbow bent at 90. Internally rotate shoulder. Test name?
Hawkins' impingement
| suggest subacromial impingement
109
4 w/o with cough, poor feeding, conjunctivitis, CXR with interstitial infiltrates. WBC with eosinophilia. Dx?
Chlamydia trachomatis
| presents at 3-16 wk of age and can be sick for weeks.
110
when and how to treat triglycerides
If >1000 would start fenofibrate in addition to lifestyle modification to lessen the risk of significant pancreatitis
can also start statin but statin won't lower TG
Omega 3 can also lower TG and LDL but does not decrease mortality or CV events so not recommended
Niacin does increase HDL and LDL but studies have not demonstrated that CV outcomes are affected
111
what medication can cause hyperthyroidism?
amiodarone
| made up of 37% iodine
112
Pt wants advice about DHEA?
It does not enhance performance or muscle strength
| Precursor to testosterone and estrogen
113
infection of the lateral nail fold
paronychia
| Tx top abx +/- TOP steroid, po ab, warm compress. I&D if not responsive
114
when leg is extended, patella deviates laterally. Dx?
patellofemoral syndrome
115
cyp450 inducer
phenytoin
116
preferred initial test in post menopausal VB?
TVUS
| less invasive than EMB and if endometrial stripe <3-4 mm then carcinoma is r/o
117
Pulmonary embolism is associated with which type of effusion?
exudative
118
unvax preggo in 1st trimester found out hubs has acute hep b. what to do?
Give HBIG and Hep B vax now
119
which vaccine preventable illness has had an increase in number of deaths in recent years?
Pertussis
| adults lose immunity. Should get booster once between 19 and 65
120
proximal muscle weakness with elevated CK
drug induced myopathy (usually d/t statin)
121
proximal muscle weakness with elevated ESR
polymyalgia rheumatica
122
best evidence to prevent fractures in postmenopausal women with osteoporosis?
Bisphosphonates
123
pt has pelvic pain but during and exam you have her raise both legs off table which intensifies her pain. Dx?
Suggests MSK etiology
If pain was improved would call this Carnett's sign which would decrease abdominal pain as the and muscles tighten because the taut muscle protects the viscera during the exam
124
Pt admitted for CHF x2 weeks develops copious semi formed stool. Dx?
C diff
| Long hospitalization even without abx use is a risk factor for c diff. Exposure to toxin
125
pt has annular rash on dorsal of hands. Bx reveals granuloma annular. Now what
No tx. Self limited.
126
when to screen for gDM?
24-28 wk
127
Boxer fx of 5th metacarpal has < 40degree of angulation. Tx?
Ulnar gutter splint
| >40 needs surgery
128
Best US measurement to estimate gestational age
Crown rump length @ 10wks pregnancy
129
Tx for HIV + with latent TB?
Isoniazid x 9 months
| Rifampin is not recommended in HIV d/t resistance and drug interactions with HART therapy
130
Pt has a cold sore and that 2 days later develops maculopapular rash in multiple areas that look like target lesions. Dx?
HSV
| Rash = erythema multiforme and HSV is the most common etiologic agent
131
What imaging study should you get for pts with hematuria?
CT urography (not RBUS)
132
what can help reduce leg pain in PAD?
Statin
133
Tx for neurogenic bladder (retention)
scheduled urination +/- Crede's maneuver
+/- bethanechol
self-cath
134
Tx for cocaine induced chest pain?
IV Ativan
135
niacin can have side effect on which organ?
Liver
| Hepatotoxitiy in elderly
136
Well controlled t2dm on insulin is now having hypoglycemia despite no change in diet or insulin. Why?
Kidney disease
137
2 y/o M isn't walking, if c/f Duchenne MD what lab test would be helpful?
CK
138
Most common cause of 24-48h food poisoning?
Staph
139
How to confirm dx of Parkinson's dz?
positive response to levodopa
140
when does mid shaft clavicle fx need surgery?
```
Older female (ie >50)
Comminution or displaced fx
clavicle shortening
```
141
Tx for postpartum urinary retention
Foley or intermittent Cath
142
common cause of wheeze in infants?
GERD
143
Dosing of amoxicillin for AOM?
80-90mg/kg/day
144
Surgeries with the highest risk of preoperative MI?
Aortic and peripheral vascular surgery
| Emergent operations
145
Tx for inpatient cellulitis w/o abscess
CTX, PCN, Cefazolin, clinda mono therapy
| If purulent drainage or IVDU or MRSA + --> vanc
146
Good exercises for low back/pelvic pain in 3rd trimester?
Core stability exercise (pilates, back extension, abd crunches)
147
Presence of skin tags means a patient is at an increased risk of?
T2DM
148
pt with polyuria, euvolemic on exam, 24h urine puts out >5L with low urine osmolality. Pt has a deficiency of?
arginine vasopressin
| Dx DI
149
problem with Sudafed in elderly?
Worsens urinary retention
150
Pt with adrenal insufficiency on 5mg pred and 0.1mg fludrocortison has cellulitis. How do you manager her steroids?
Increase red to 15mg and keep fludrocortisone at current dose
Only increase fludrocortisone to stress dosing for surgery or major infection
151
which elderly ppl have highest risk of dying in a heat wave
Home bound
bed bound
unable to do ADLs
152
4 w/o m prominence on L scrotom
| Oblong, nontender, non reducible, light transmitting mass closely adhered to testes. Dx and tx?
Hydrocele
| Observe - resolves in week to months
153
Pt wants to take a herbal supplement for anxiety. Rec?
Kava
works in short term (up to 6 months)
avoid hepatotoxins
154
pain/tingling in medial aspect of ankle and plantar surface. worse with activity. Reflex hammer inferior to the medial malleolus causes parathesia. Dx?
Tarsal tunnel syndrome
155
tx for tooth abscess
clinda
156
pt w/ anosmia but no congestion. now what?
MRI brain - rare brain tumors can do this
157
asyx pt has Tbili 1.8, indirect bili 1.3. all other labs nl. dx?
Gilbert syndrome
| AD, elevated indirect hyperbole d/t impaired glucuronyl transferase activity
158
which anemias have a normal rdw?
beta thalassemia
| rdw measures variability
159
tx for TMJ
Can do dental splints, but the majority of cases are self limiting
160
What causes most cases of acute interstitial nephritis?
drug induced
usually 2 weeks after starting medication
associated with NSAIDs, abx (cephalosporins, PCN, sulfonamies, ahminoglycosides, rifampin), diuretics, allopurinol
161
Tx for orthostatic hypotension
Fludrocortisone
Midodrine
Physostigmine
162
What decreases mortality in CHF?
ACEI
B block
NOT CCB - decrease cardiac contractility and cause peripheral vasodilation
163
pt with hypercalcemia has a normal PTH hormone level. How do you interpret?
Dx hyperPTH
| IF parathyroid function was appropriate PTH would be low
164
RFs for latent TB to progress to active TB?
```
Lung CA
T2DM
alcoholism
contact w/ active TB person
pt on immunosuppressant
parenchyma lung dz (COPD, silicosis)
```
165
goal Hgb range for pts with CKD?
10-12
166
characteristic lab findings in intrahepatic cholestasis of pregnancy?
elevated total bile acids
NL GGT
NL coags
167
which intervention for CTS has the best evidence to delay need for surgery
Steroid injection
| Although this isn't first line
168
work up for microhematuria (3-5 cells) in a male
RVUS
Cytology
Cystoscopy
169
Valvular abnormality in Marfans
Mitral valve prolapse
This can cause aortic insufficiency
Can lead to aortic root dilation
170
toddler refuses to eat meals, only cookies. What do. you do?
Provide healthy snacks for all meals and end the meal if kiddo won't eat
Do not offer food as a reward
171
pt has mitosis, unilateral pupil mitosis, decreased sweating. Next?
CXR
C/f Horner's syndrome
Looking for pan coast superior sulcus tumors of the lung
172
most likely cause of hearing loss in newborns?
genetic dz
173
What helps iron absorption?
Acidic environments (ie take with OJ)
174
most tines improves with TOP therapy, except?
tines capitis
175
Tx for antiphospholipid syndrom in a gravid pt?
ASA and heparin
176
when is dizziness concerning
when it is associated with other neurologic syx (diplopia, difficulty with speech, weakness, etc)
177
Ocular misalignment on cover/uncover test when the corneal light reflex is deviated from normal position to slightly nasal to mid pupil. Misaligned eye then moves to fixate on a held object when the opposite eye is covered, but back to normal when other eye is uncovered
Strabismus
178
slutty dude with chlamydia won't tell you name of partners. how do you expedite tx of partners?
Make Rx for patient + Rxs for expedited partner therapy (written to EPT)
179
best pre-treatment to prevent contrast induced nephropathy when undergoing cardiac cath?
hydration with sodium bicarb fluids
180
After AOM in a toddler parent noes changes in hearing. Exam TM is retracted and tympanogram shows a flat tracing. Next?
Unilateral serous otitis is unlikely to cause delayed language
Observe (no antihistamines or steroids)
if hearing loss >3 months --> tympanovstomy tubes
181
most effective at helping with nipple pain in Breast feeding?
Education on positioning
182
preferred ankle support in a pt with a sprain
Simi rigid stirrup brace (air cast)
| OR lace up support
183
Tx for meth user that wants sobriety?
CBT
| No FDA approved meds
184
Peds nurse has fever, faint maculopapular irregular reticulate exanthema over thighs and upper arms. Symmetric synovitis in several DIP, PIP, MCP joints, wrist and elbow. Dx?
Parvo B19
Erythema inectiosum
common in younger women
185
Do you have to stop statin in cirrhosis pts?
No, the CV benefit outweighs risk
186
Pt is now asplenic. Which tax does he need?
Pneumococcal
Meningococcal
Hib
187
Ab specific to RA?
anti CCP Ab
188
Young pt has OAB/Urge incontinence. Best 1st line tx?
Pelvic floor exercises
| can be more effective than medications
189
What tx can make grave's ophthalmopathy worse?
Radioactive iodine
| hyperthyroid syx
190
22 y/o FOOSH and has torn RTC tendon on MRI. Next?
Surgery
| Acute tears need to be repaired within 6 weeks
191
Pap: NILM, HPV +, non typable. Next?
Pap in 1 year
| IF she were HPV 16 or 18 + --> colposcopy
192
Imiquimod (Aldara) is FDA approved treatment for?
External anogenital warts
193
septic pt blood cx + for strep Boris. Now what?
Needs c-scope to r/o CRC
| ECHO to r/o endocarditis
194
Interventions for hyperK rapidly
Sodium bicarb
insulin + glucose
Albuterol
- lokelma works but isn't rapid
195
how do you counsel about nicotine replacement therapy?
NRT usually doubles the smokers chances of quitting
196
when can kids drink cows milk?
1 y/o +
| not enough vitamin E, iron, essential fatty acids and overburdens them with too much protein, Na, K
197
Leading cause of death in first 30 days s/p bariatric surgery
PE
198
What age is a H&H indicated at a WCC?
12 months
199
What is important to be aware of as far as pharmacokinetics in geriatric patients?
Increased % of body fat
Decrease in lean body mass
Causes an increased distribution of fat soluble drugs such as diazepam
Increases half life of fat soluble drugs
200
Medication that improves claudication in PAD patient
Cilostazol (Pletal)
| Antiplatelet therapy reduces risk of MI but doesn't affect claudication
201
what is diagnostic of SBP in a febrile cirrhotic?
paracentesis fluid with PMNs >250
202
young adult recently on camping trip returns with fever, myalgias, and pink blanching rash that includes palms/soles. dx tx?
Ricketsial dz- likely rosy mountain spotted fever
| Tx doxy 100 BID
203
pt climbing mountain gets HA nausea and progresses to ataxia and confusion. Next?
give oxygen and immediate descent
| dx - high altitude cerebral edema
204
thromboses hemorrhoid, next step for relief
excision
| steroids help but not enough apparently
205
RFs for Macular degeneration
smoking
| HTN
206
which pap cytology finding has the highest risk of developing CA?
Atypical glandular cells not otherwise specific (AGC-HOS) - CA rate of 17%
HSIL - 3% CA rate
207
What does a p value of <0.05 mean?
There is a 5% likelihood that the results occurred by chance alone
208
6 y/ohas fever, joint pain, colicky belly pain after a viral URI. Has a palpable dark purple rash. Dx
Henoch-schonlein purpura
209
Tx that help prevent postherpetic neuralgia
antiviral (acyclovir, famiciclovir)
| low dose TCA may also help (amitriptyline)
210
what other lab tests help confirm vit b12 deficiency
elevated methylmalonic acid and homocysteine
| precursors that require b12 for metabolism
211
65 y/o
weakness, fatigue, weight loss, recurrent infections, bleeding
Hepatosplenomagaly, LN
Anemia, monoclonal IgM peaks, Bence-Jones protein
Xray w/o lytic lesions
Bone Marrow bx --> lymphocytes
Dx?
Waldenstrom's macroblobulinemia
Non Hodgkins lymphoma has similar presentation, but no monoclonal gammopathy or Bence-Jones protein. Bx would have had distinctive malignant lymphocytes
212
19 y/o F runner w/ constant groin pain. Limited hip ROM on flexion and internal rotation of hip. Xray NL. Dx?
Stress fx of R femoral neck
213
Tx for labial adhesion 4 y/o that has frequent UTIs
TOP estrogen cream
| Makes them prone to UTIs
214
BMI for anorexia?
17 and under
215
Alzheimer's pt on cholinesterase inhibitor is wandering and pacing and family is asking for more medications
No additional treatments
| not much will help the wandering
216
Alternative therapy for pt that can't tolerate bisphosphonate that would be the most effective
Zoledronic acid (Recast)
217
F patient tested positive for chlamydia. What do you counsel
Need to treat her and every partner she has had in the past 60 days
Needs to use barrier method for 7 days after treatment
Failure to treat her would increase her risk of infertility later
218
when is morning sickness considered abnormal?
After 9 weeks of gestation
219
Most likely to cause seizure in elderly pt?
CVA, especially hemorrhagic cva
220
surgical therapy for unilateral tremor and dyskinesia in Parkinsons
Thalamotomy and pallidotomy
221
characteristic lab finding in pyloric stenosis
hypochloremic alkalosis
222
The accuracy of a Mini mental exam is affected by?
Education level of the pt
223
what antibiotics can increase the risk of statin toxicity?
Erythromycin or clarithromycin
224
what causes rhinitis medicaments?
```
IN decongestants (ie phenylephrine)
causes rebound congestion
```
225
Elderly woman has nighttime incontinence, wakens from sleep with intense desire to void but doesn't make it to bathroom, dx and mech?
Urge incontinence
| caused by detrusor instability
226
what measures the severity of DKA
pH
Bicarb
AG
Mental status
227
pt has a lesion suspicious for melanoma. Which bx technique would you do?
elliptical excision
Only get a punch bx if the size of the lesion is too big for excision because there is a risk of missing the malignant cells
228
Pt at term is admitted for HTN and proteinuria. Next day she has a drop in PLT and LFTs double. Now what?
Induce labor if cervix favorable
c-section if not
HELLP syndrome
229
Toddler bangs his head when he is frustrated. Has some swelling on exam. What do you tell parent?
They typically outgrow this by age 3
230
28 wk preggo is in a MVA and on a backboard in c-collar. Until her spine is cleared, how do you position her?
supine w/ uterus manually deflected laterally
| try to prevent uterus from compressing great vessels
231
Start bisphosphonate based on which FRAX score?
10 year risk of major fracture is 20%+
OR 10 year probability of hip fx is 3%+
T score -2.0 is osteopenia
232
which fluoroquinolone should not be used for UTI?
Moxifloxacin
| Poor urinary concentration
233
Most common type of adverse event in a hospitalized pt > 65
Drug related events
| NOT wounds or falls
234
what is considered an adequate trial of an antidepressant?
4-6 weeks
235
Compared to po opioids, epidurals in labor increase rate of?
prolonged second stage of labor
increased rate of instrument assisted vaginal deliveries
increased likelihood of maternal fever
NOT c-section
236
What does a USPTF D recommendation mean?
Moderate or high certainty that the service offers no benefit or that the harm outweighs benefit
237
Which type of mood stabilizers can induce w/d is stopped abruptly
Venlafaxine (Effexor)
Much more severe than with SSRIs
syx - agitation, anorexia, confusion, impaired coordination, seizures, sweating, tremor, vomiting
Make dose changes gradually
238
Pt has RA syx but ANA and rF negative, elevated esr. Now what?
Still has RA
Clinical diagnosis counts
ANA + in 35% of RA pts
239
What medications can help prevent contrast induced renal failure
N-acetylcysteine
| Sodium bicarb
240
Most common cause of proteinuria in children?
Orthostatic proteinuria
| 60% of asymptomatic proteinuria in kiddos
241
What helps to relieve pain in a osteoporotic fx?
SQ or IN calcitonin
242
80 y/o M with heel pain that gets worse as day progresses. Xray normal. Dx?
Fat pad atrophy
243
what imaging should you get to confirm if T2DM has osteomyelitis?
MRI
| NOT CT or tagged WBC study
244
When do you give tpn?
when patient has poorly functioning GI who cannot tolerate enteral feeding
245
Most effective Rx for head lice?
Malathion (Ovide)
| Less toxic than lindane. More effective than permethrin
246
Most common stress fx in kiddos?
Tibia
| Actually most common stress fx in kids and adults (about 50%)
247
Pt has osteoporotic vertebral compression fx. On oxycontin and NSAIDs, what else is helpful in pain control?
Calcitonin either IN or SQ
| pain relief within a few days
248
2 y/o is flat footed with weight bearing but with toe standing and sitting the arch appears. Now what?
Reassure the parents
Only pathologic if it is painful
Usually spontaneously resolve after 1 year of walking
249
Tx for overt hyperthyroidism in 1st trimester
Propyltiouracil
| Cannot use methimazole in 1st trimester. Cannot observe d/t hyperthyroid having Ads on mother and fetus.
250
Formula for NNT
1/ARR
251
Syx of Mag toxicity
respiratory depression
| Reason to check reflexes
