Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
148 Cards in this Set
- Front
- Back
|
An otherwise healthy 10-year-old female presents with a papulovesicular eruption on one leg.It extends from the lateral buttock, down the posterolateral thigh, to the lateral calf. It is mildly painful. The patient’s immunizations are up to date, including varicella and MMR. Her family has a pet cat at home, and another child at her school was sent home with a rash earlier in the week.Dx?
|
Herpes Zoster can occur either from a wild or a vaccine strain of VZV in vaccinated children. incidence is low. cases are mild and uncomplicated
|
|
|
T/F: The harms of screening for prostate cancer after the age of 75 outweigh the benefits
|
True. Potential harms include urinary incontinence, erectile dysfunction, bowel dysfunction, and death, and the USPSTF found no direct evidence of benefits from screening. the best candidates for screening are men age 50 or older with a life expectancy [1]10 years. Prostate-specific antigen (PSA) is more sensitive than the digital rectal examination.
|
|
|
A 30-year-old female with dysfunctional uterine bleeding asks about treatment options. An examination is normal and blood testing is negative. She is unmarried and is undecided about having children. Which one of the following would be the most appropriate treatment for this patient?
|
n a young woman unsure about having children, the levonorgestrel releasing IUD is most effective and preserves fertility.
|
|
|
You are treating an 18-year-old white male college freshman for allergic rhinitis. It is September, and he tells you that he has severe symptoms every autumn that impair his academic performance. He has a strongly positive family history of atopic dermatitis.
Which one of the following medications is considered optimal treatment for this condition? |
Topical intranasal glucocorticoids are currently believed to be the most efficacious medications for the treatment of allergic rhinitis.
|
|
|
You are treating a 53-year-old female for a deep-vein thrombosis in her left leg. The use of compression stockings for this problem has been shown to:
|
decrease the risk of post-thrombotic syndrome. characterized by chronic pain, swelling, and skin changes in the affected limb.
|
|
|
Treatment with corticosteroids is now NOT recommended for acute laryngotracheitis (croup), only chronic, severe.
|
False. A single dose of dexamethasone, either orally or intramuscularly, is appropriate. Corticosteroid therapy shortens emergency department stays and decreases the need for return visits and hospitalizations. It is indicated for patients with croup of any severity.
|
|
|
In the development of clinical guidelines, which one of the following is rated as the strongest and highest-quality evidence?
A. Evidence from randomized, placebo-controlled studies B. Evidence from nonrandomized, double-blind, placebo-controlled studies C. Evidence from nonrandomized, double-blind, crossover, placebo-washout–controlled studies D. Evidence obtained from well-designed cohort or case-control analytical studies from more than one center or research group E. Evidence based on reports of expert committees or opinions of respected authorities in the appropriate specialty area |
A. Randomized, controlled studies yield stronger evidence than other types of studies, especially case-control or cohort studies, because randomization provides the greatest safeguard against unanticipated study bias.
|
|
|
A 55-year-old male who had a recent episode of atrial fibrillation that converted in the emergency department is asymptomatic and currently in sinus rhythm. He is in good health otherwise and has no history of hypertension, diabetes mellitus, heart failure, transient ischemic attack, or stroke.
Which one of the following would be best for preventing a stroke in this patient? |
Aspirin. The stroke risk index CHADS , used to quantify risk of stroke for patients who have atrial fibrillation and to aid in the selection of antithrombotic therapy, is a mnemonic for individual stroke risk factors: C (congestive heart failure), H (hypertension), A (age 75), D (diabetes mellitus), and S (secondary prevention for prior ischemic stroke or transient attack—most experts include patients with a systemic embolic event). Experts typically prefer treatment with aspirin rather than warfarin when the risk 2 of stroke is low.
|
|
|
Which one of the following serum proteins is typically DECREASED in a hospitalized patient with sepsis?
A. Complement C3 B. Ferritin C. C-reactive protein (CRP) D. Albumin E. Fibrinogen |
The acute phase response refers to the multiple physiologic changes that occur with tissue injury. The synthesis of acute-phase proteins by hepatocytes is altered, leading to decreased serum levels of several of these proteins, including albumin and transferrin. Serum levels rise for other proteins, such as ceruloplasmin, complement proteins, haptoglobin, fibrinogen, and C-reactive protein. Serum levels of ferritin may be extremely high in certain conditions, but are also influenced by total-body iron stores.
|
|
|
A 25-year-old female is concerned about recurrent psychological and physical symptoms that occur during the luteal phase of her menstrual cycle and resolve by the end of menstruation. She wants help managing these symptoms, but does not want to take additional estrogen or progesterone. What can evidence based treatment can you provide?
|
spironolactone during luteal (secretory phase) RCTs show improved sx of PMS.
|
|
|
55 yo M p.w pain in R eye and dec vision x 10min. Eye injured while hitting metal stake, wasn't wearing goggles. subconjunctival hemorrhage surrounding cornea. Iris is irregular. What is C/I prior to emergency transfer to opthomologist?
|
Attempting tonometry. patient has possible global rupture 2/2 penetration thru cornea. You can provide analgesic, assess acuity and provide antiemetic (valsalva can increase IOP)
|
|
|
23 yo G1P0 @ 36w p/w ankle swelling and h/a x 2d. FH 35cm, FHT 140/min, 2+ edema BP 144/92, UDip +1 protein. SVE 2cm/90%/-1 vertex. Next step?
|
Lab eval, NST, and 24 hr protein urine. Patient most likely has pre-E. Definitive treatment at GA is delivery.
|
|
|
What injection site is best for preventing hypoglycemia in 14yo M w/ DM who wishes to participate in track?
|
abdomen. nonexercised injection site will reduce risk of hypoglycemia. If leg was used, it may accelerate insulin absorption --> increased insulin.
|
|
|
Best diagnostic test for vit D def?
|
25-OH vit D. 1,25 has too short a half life.
|
|
|
A 69-year-old male presents with a 2-week history of fever, fatigue, weight loss, and mild diarrhea. He is found to have a mildly tender mass in the left lower quadrant of the abdomen.
The most likely diagnosis is: |
diverticulitis.
|
|
|
A 35-year-old white gravida 2 para 1 sees you for her initial prenatal visit. Since delivering her first child 10 years ago, she has developed type 2 diabetes mellitus. She has kept her disease under excellent control by taking metformin (Glucophage). A recent hemoglobin A1c level was 6.5%.
You should now treat her diabetes with: |
human insulin. The safety of most oral hypoglycemics in pregnancy has not been established w/ regard to teratogenic potential. All oral agents cross placenta --> neonatal hypoglycemia. Insulin requirements increase throughout gestation.
|
|
|
Child p/w fever coryza and cough. He has red welts and superficial abrasions on chest and back. parents tell you its "where the sickness is leaving body" and were produced by coin. Where are they from?
|
SE Asia. sometimes hard to tell from abuse.
|
|
|
12 yo white male has acute asthma attack that is refractory to inhaled B2-agonist. Next most appropriate addition to acute outpatient management?
|
oral corticosteroids. short course. inhaled corticosteroids should be used to suppress the sx of chronic persistent asthma.
|
|
|
18 yo p/w recurrent unpredictable episodes of palpitations, sweating, dyspnea, GI distress, dizziness and paresthesias. Moderate obese. Labs normal. Most likely dx?
|
panic d/o attacks are sporadic and last 10-60min. Pheochromocytoma is associated w/ h/a and HTN and usually in THIN patients.
|
|
|
Which one of the following is most associated with falls in older adults?
A. Diphenhydramine (Benadryl) B. Atorvastatin (Lipitor) C. Metformin (Glucophage) D. Memantine (Namenda) E. Theophylline (Theo-24) |
Benadryl. anticholinergic effect. These classes include benzodiazepines, antidepressants, antipsychotics, antiepileptics, anticholinergics, sedative hypnotics, muscle relaxants, and cardiovascular medications.
|
|
|
78 yo white male scheduled for CT w/ contrast. He has DM2, CHF, ACD and renal insufficiency. What can reduce risk of contrast-induced nephropathy?
|
isotonic bicarbonate infusion. low osmolar or iso osmolar contrast should be used to prevent nephropathy in at risk patients. volume should be as low as possible. also evidence supports hydration before procedure w/ isotonic saline or isotonic NaHCO3 solution.
|
|
|
Define stress incontinence
|
Patient senses urge to void but is unable to inhibit leakage long enough.
|
|
|
Define functional incontinence
|
Lower UT function is intact but other factors such as immobility and cog impairment lead to incontinence
|
|
|
40 yo obese black male p/w daytime sleepiness. + cataplexy w/ laughter. Sleep study negative for OSA. Rx?
|
methyphenidate (ritalin) and other stimulant remain drugs of choice.
|
|
|
42 yo female p/w pleuritic chest pain. probility of PE is low. what test should be ordered to further evaluate patient?
|
ELISA-based D dimer. patient who have low or moderate pretest prob of PE should have d-dimer testing as the next step in establishing dx
|
|
|
A 17-year-old soccer player presents for a preparticipation examination. His family history is significant for the sudden death of his 12-year-old sister while playing basketball, and for his mother and maternal grandmother having recurrent syncopal episodes.
|
resting EKG (NOT STRESS). should be highly suspicious of long QT syndrome. if resting EKG shows QTc > 460ms female or > 440 ms male. Always consider because it can be a cause of sudden death. Management: BB, Implantable cardioverter defibrillator and no competitive sports.
|
|
|
What dietary supplement has been shown to reduce sx and possibly reduce progression of OA?
|
Glucosamine sulfate
|
|
|
Which atypical antipsychotic would you choose in a patient who is concerned about weight gain?
|
Aripiprazole (abilify) - least associated with weight gain
|
|
|
75 yo white female p/w back pain and +BJ proteins in urine. Next appropriate step?
|
Bone marrow exam. e diagnosis is confirmed by a bone marrow examination showing >10% plasma cells in the marrow. The serum level of monoclonal immunoglobulin is typically >3 g/dL.
|
|
|
20 yo non smoker p/w sudden onset of chest pain. CXR shows small pneumothorax (<15% lung volume). No RD and VSS. SaO2 98%. Best next step
|
Patient w/o disease who develops spontaneous pneumothorax can be managed as an outpatient w/ analgesics and f/u w/in 72hrs.
|
|
|
when is a chest tube required in pneumothorax?
|
when pneumothorax is > 15%
|
|
|
T/F: osteoporosis can be diagnosed in post-menopausal women w/ h/o fracture in low impact setting.
|
True. do not need BMD score, however, a BMD 2 SD below mean can be diagnostic also (T < -2.5)
|
|
|
current exercise recs for healthy adults?
|
Current recommendations are for healthy adults to engage in 30 minutes of accumulated moderate-intensity physical activity on 5 or more days per week.
|
|
|
What are most common causes of hypercalcemia?
|
Primary hyperparathyroidism and malignancy are the most common causes of hypercalcemia, accounting for about 90% of cases. An intact parathyroid hormone (PTH) level should be obtained initially, as the results will indicate what kind of additional evaluation is needed.
|
|
|
You are caring for a 70-year-old male with widespread metastatic prostate cancer. Surgery, radiation, and hormonal therapy have failed to stop the cancer, and the goal of his care is now symptom relief. He is being cared for through a local hospice. Over the past few days he has been experiencing respiratory distress. His oxygen saturation is 94% on room air and his lungs are clear to auscultation. His respiratory rate is 16/min. Next step?
|
morphine. Dyspnea is a frequent and distressing symptom in terminally ill patients. In the absence of hypoxia, oxygen is not likely to be helpful. Opiates are the mainstay of symptomatic treatment.
|
|
|
72 yo white female admitted w/ acute HF. Echo shows no valve dz and no segmental wall motion abnormalities. EF is 55%. HR 72. Most likely cause of HF?
|
diastolic dysfunction - It is due to left ventricular hypertrophy as a response to chronic systolic hypertension. The ventricle becomes stiff and unable to relax or fill adequately, thus limiting its forward output. The typical patient is an elderly person who has systolic hypertension, left ventricular hypertrophy, and a normal ejection fraction (50%–55%).
|
|
|
A new drug treatment is shown to reduce the incidence of a complication of a disease by 50%. If the usual incidence of this complication were 1% per year, how many patients with this disease would have to be treated with this medication for 1 year to prevent one occurrence of this complication?
|
200. this represents "number needed to treat" which is the inverse of "relative risk reduction"
|
|
|
Recommendations of 2008 pneumococcal vaccine
|
All persons between the ages of 19 and 64 who smoke should receive this vaccine. One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions. after age 65, repeat immunization are not recommended, if already received by age 65.
|
|
|
A 64-year-old white male presents to the emergency department with a 48-hour history of left lower quadrant pain. After a thorough history and a physical examination you conclude that the patient has diverticulitis. The patient is allergic to metronidazole (Flagyl).
You recommend a clear-liquid diet, a follow-up visit with his primary care physician in 48 hours, and treatment with: |
accepted OP regimen for diverticulitis is augmentin (amox/clavu) which does include anaerobic coverage.
|
|
|
T/F: ciprofloxacin covers for anerobes?
|
false. only gram negative coverage, thats why its not an option in patient allergic to flagyl
|
|
|
What is most likely cause of fecal incontinence in intstutionalized elderly?
|
overflow incontinence 2/2 to constipating medications
|
|
|
T/F: DM can cause decreased rectal sensation
|
False.
|
|
|
What findings would be pathognomonic for slipped capital femoral epiphysis?
|
limited IR of flexed hip. Look for SCFE in young adolescents during growth spurt. physical activity, obesity and male gender are risk factors
|
|
|
74 yo p/w diarrhea x 4d. +nausea, 1 episode of vomiting. No hx of unusual foods and not traveled recently. VSSAF, mild diffuse tenderness on abd palpation. labs wnl. most likely cause?
|
Campylobacter. if viral wouldn't be that long. If Staph, would have cleared in 2 days. E.coli or shigella would be more pronounced bloody diarrhea and shigella would show an elevated WBC
|
|
|
50-year-old female with significant findings of rheumatoid arthritis presents for a preoperative evaluation for planned replacement of the metacarpophalangeal joints of her right hand under general anesthesia. She generally enjoys good health and has had ongoing medical care for her illness.
Of the following, which one would be most important for preoperative assessment of this patient’s surgical risk? |
cervical spine imaging. In patient w/ long standing RA detection of atlantoaxial subluxation would be most important for preventing a catastrophic spinal cord injury during intubation.
|
|
|
A 68-year-old white male with diabetes mellitus is hospitalized after suffering a right middle cerebral artery stroke. A nurse in the intensive-care unit calls to advise you that his blood pressure is 200/110 mm Hg. You should:
|
continue to monitor patient. DO NOT GIVE ANTI-HTN meds just yet. for patients with a systolic blood pressure <220 mm Hg or a diastolic blood pressure <120 mm Hg. The elevated blood pressure is thought to be a protective mechanism that increases cerebral perfusion, and lowering the blood pressure may increase morbidity.
|
|
|
What is the most clearly established advantage of angiotensin receptor blockers (ARBs) when compared with ACE inhibitors in patients with HTN and DM
|
reduce risk of persistent cough. Remember ACEi in DM patients w/ HTN to prevent microalbuminuria and progressive nephropathy
|
|
|
What is the most likely cause of chronic unilateral nasal obstruction in an adult?
|
nasal septal deviation. Anatomic abnormalities, are the most frequent cause of constant unilateral obstruction, with septal deviation being most common.
|
|
|
MCC of nasal obstruction
|
mucosal disease aka common cold
|
|
|
What lab can one run to determine if a patient is resonding to oral iron supplements after dx of iron def anemia?
|
reticulocytosis about 1 week after administration of iron.
|
|
|
best INITIAL management for hypercalcemic crisis?
|
IV saline. f the clinical status is not satisfactory after hydration alone, then renal excretion of calcium can be enhanced by saline diuresis using furosemide.
|
|
|
24 yo otherwise healthy M p.w sore throat x 2d. non-productive cough, erythmatous pharynx but no exudates. No LAD and CTAB. txt?
|
analgesics and supportive care
|
|
|
clinical predictors of strep pharyngitis?
|
These include tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever. The presence of three or four of these criteria has a positive predictive value of 40%–60%, and the absence of three or four of these criteria has a negative predictive value of 80%.
|
|
|
A 28-year-old male is seen for follow-up of acute low back pain. He has a past history of substance abuse. Ibuprofen and acetaminophen have helped some, but he is experiencing muscle spasms. What med should you avoid in this patient?
|
Carisoprodol (soma). Carisoprodol is metabolized to meprobamate, which is a class III controlled substance. It has been shown to produce both physical and psychologic dependence.
|
|
|
You test a patient’s muscles and find that his maximum performance consists of the ability to move with gravity neutralized. This qualifies as which grade of muscle strength, on a scale of 5?
|
2! 0 = inability to contract; 1 = contraction w/o movement; 3 = movement against gravity only; 4 = against some resistance; 5 = against substantial resistance
|
|
|
A 40-year-old male with acute pancreatitis has an alanine transaminase (ALT) level that is five times normal. Which one of the following is the most likely diagnosis?
|
Gallstone pancreatitis.
|
|
|
High levels of CRP in setting acute pancreatitis are indicative of:
|
pancreatic necrosis
|
|
|
MR + large ears, a prominent jaw, and large symmetric testicles. Dx?
|
Fragile X. MCC of MR v any other genetic d/o except down's.
|
|
|
According to the U.S. Preventive Services Task Force, multivitamin supplements in the geriatric age group:
|
are NOT recommended for prevention of any d/o.
|
|
|
Which anti-hypertensive drug is most likely to cause ankle edema?
|
amlodopine (norvasc). Most common side effects of CCB are 2/2 vasodilation (dizziness, nausea, hypotension, cough and pulmonary edema).
|
|
|
27 yo korean female p/w several painful yellow, sharply defined ulcers. She denies recent sexual activity. Tzanck smear, CBC, serology negative. +aphthous ulcers of mouth and erythematous margin at site where venicpuncture was performed for labs. Dx?
|
Behcet's syndrome -recurring genital and oral ulcerations and relapsing uveitis. can be associated w/ cutaneous hypersensitivity.
|
|
|
runner c/o worsening pain on lateral aspect of foot. TTP over lateral 5th metatarsal. +pain with increase loading. Dx?
|
Stress fracture. common in runners 2/2 overuse. recommend to increase distance gradually.
|
|
|
Patient confused and seizing in ER. Sodium level 116mmol/L w/ normal renal and LFTs. initial Tx after ABCs performed?
|
hypertonic saline. only raise 1-2mmol/L/hr to prevent central pontine myelinolysis. only use hypertonic saline until seizures stop
|
|
|
29-year-old gravida 1 para 0 at 8 weeks gestation is concerned about Down syndrome. She had a sibling with Down syndrome, and she and her spouse want to know what antenatal tests are available to them.
Which one of the following has the best detection rate for Down syndrome in the first trimester of pregnancy? |
CVS. offered at 10-13w w/ 97.8% detection rate for Down's
|
|
|
What offers the best detection rate for down's syndrome in antepartum period?
|
amniocentis, however it can't be offered until 16-18w
|
|
|
A 72-year-old male presents to your clinic in atrial fibrillation with a rate of 132 beats/min. He has hypertension, but no history of heart failure or structural heart disease. He is otherwise healthy and active.
The best INITIAL approach to his atrial fibrillation would be: |
ventricular rate control with a calcium channel blocker or β-blocker, and warfarin for anticoagulation. rate control is more important than rhythm control.
|
|
|
A 7-year-old Hispanic female has a 3-day history of a fever of 40.0°C (104.0°F), muscle aches, vomiting, anorexia, and headache. Over the past 12 hours she has developed a painless maculopapular rash that includes her palms and soles but spares her face, lips, and mouth. She has recently returned from a week at summer camp in Texas. Her pulse rate is 140 beats/min, and her blood pressure is 80/50 mm Hg in the right arm while lying down.
Which one of the following is the most likely diagnosis? |
RMSF. Rash - blanching macules on ankles and wrists or forearms that evolve into maculopapules.
|
|
|
How do you monitor adequacy of anticoagulation in patient on enoxparin (lovenox)?
|
anti-factor Xa levels. usually required in obese patients w/ renal failure
|
|
|
Under current guidelines, hospice programs are most likely to serve patients dying from:
|
cancer or terminal illness w/ life expectancy of 6mo or less.
|
|
|
Next step in individual who presents with positive PPD?
|
CXR. two-step now is recommended in those with initial negative test
|
|
|
What common OTC medication is a cause of decreased absorption of oral calcium?
|
PPI.
|
|
|
50 yo M p/w f/cp. cp worse in supine and w/ deep inspiration. cp improves when leaning forward. EKG shows diffuse ST elevations. troponins negative. initial Txt?
|
aspirin. newer evidence show that it may be beneficial to add cholchocine.
|
|
|
37 yo p/w 2 week h/o lesion. coralred flourescence under wood's light w/ mild scaling. most appropriate txt?
|
erythromycin. suggests corynebacterium infection. remember microsporum flouresces GREEN!
|
|
|
40 yo M p/w for f/u of elevated LFT. BMI 37.7 and +EtOH 2beers/week. AST and LFT are 2x the upper limits of normal. next most appropriate step?
|
testing for viral hep. NASH is most likely dx, but should r/o hep first.
|
|
|
In a black patient w/ systolic HF, but has a history of angioedema w/ lisinopril, what medication will improve both sx and survival in this patient?
|
For blacks who cannot tolerate an ACEi, combination of direct-acting vasodilators such as isorbide and hydralazine is preferred.
|
|
|
Which CCB should not be used in HF?
|
verapiamil because it has inotropic effects.
|
|
|
women older than 65 who have low serum TSH (indicating physiologic hypothyroidism) are at increased risk for what complication?
|
hip fractures
|
|
|
A young man with weight loss, oral thrush, lymphadenopathy, and ulcerative esophagitis is likely to have...
|
HIV infection (look for IVDA history). esophageal disease develops in more than half of all patients w/ advanced infections (2/2 candida, CMV, HSV)
|
|
|
first line therapy for localized impetigo (2/2 to S aureus or pyogenes)
|
can use topical antibiotics (shown to be as effective as oral antibiotics like erythromycin.
|
|
|
25 yo @ 31w p/w painful UCx and is 3/50%/-1. GBS negative. treated w/ toco/BMTZ/Abx and d/c home. returns 1 week later SVE unchanged but UCx x 8hrs. Next step in management?
|
expectant managment. More steroids does not confer more benefit than a single dose. since SVE unchanged these are preterm Cx not preterm labor and thus no need for tocolysis
|
|
|
Which antidepressant has shown the most favorable risk-to-benefit ratio in children and adolescents?
|
fluoxetine is the only SSRI recommended
|
|
|
trigger points for fibromyalgia
|
medial scapula borders, posterior neck, upper outer quadrants of the gluteal muscles and medial fat pads of the knees
|
|
|
A 47-year-old female presents to your office with a complaint of hair loss. On examination she has a localized 2-cm round area of complete hair loss on the top of her scalp. Further studies do not reveal an underlying metabolic or infectious disorder.
Which one of the following is the most appropriate initial treatment? |
intralesional triamcinolone (corticosteroid). findings c/w alopecia areata thought to be caused by localized autoimmune rxn to hair follicles.
|
|
|
The preferred antibiotic treatment for community-acquired pneumonia in a young adult in the ambulatory setting is:
|
azithromycin to cover for atypicals (mycoplasma pneumoniae)
|
|
|
MCC presenting sx of OSA
|
excessive daytime sleepiness
|
|
|
What asthma med is recommended in all 4 stages of COPD (mild-severe)?
|
short acting inhaled B2 agonists PRN dyspnea. use long acting bronchodilators (salmeterol) in later stages and inhaled corticosteroids in severe stage.
|
|
|
50 yo c/o R shoulder pain x 6 months and decreased ROM. XR negative. Refractory to NSAIDs. treatment should include:
|
PT w/ home exercises. Most likely adhesive capsulitis or degenerative RC tendionopathy. outpatient treatment includes NSAIDs, subacromial cortisone injections and PT
|
|
|
n assessing the nutritional status of an infant it is useful to know that birth weight is expected to be regained within:
|
14 days
|
|
|
3 yo BIB mother. +hip pain 37.6C temp, cries with weight bearing on R leg and will not allow leg to be moved. XR negative. Most appropriate next step?
|
CBC and ESR. worried about septic arthritis of the hip (v transient synovitis). if these are positive, can consider aspiration of joint by experienced practitioner.
|
|
|
A 55-year-old male is found to have three hyperplastic polyps on a routine screening colonoscopy. He has no personal or family history of colon cancer.
This patient’s next colonoscopy should be in: |
10 years. Patients with hyperplastic polyps are considered to have normal colonoscopy findings and can be followed up in 10 years, unless they have hyperplastic polyposis syndrome.
|
|
|
conduct d/o v oppositional defiant d/o
|
DSM-IV criteria for oppositional defiant disorder, defined as a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months.
|
|
|
In patients with type 2 diabetes mellitus, intensive glycemic control has not been shown to be beneficial for which one of the following diabetic complications?
|
cardiovascular disease. Hyperglycemic control does reduce risk of CVD in DM1. in DM 2 It does help reduce microvascular complications such as retinopathy, nephropathy, and neuropathy.
|
|
|
Does nicotine gum work effectively w/ varenicline (partial nicotinic Ach agonist)?
|
Nope. blocking nicotinie receptors in brain provides lower stimulation therefore reducing reinforcement. Medication also blocks benefits of nicotine replacement products
|
|
|
what is more likely to occur w/ glipizide (sulfonylurea) than w/ metformin?
|
hypogyclemia. Metformin does not cause hypoglycemia but do not use in renal impaired as it causes lactic acidosis. It also causes weight loss (compared to other oral antidiabetic) and GI distress
|
|
|
Typically, a high-grade squamous intraepithelial lesion (HSIL) of the cervix is treated with ablation or excision. In which age group can treatment be deferred?
|
HPV infection is common and transient in most young women in their first few years of sexual activity. With careful follow-up, they can be observed rather than treated for HSIL.
|
|
|
What vital signs would indicate that the patient suffers from severe anorexia nervosa?
|
hypotension, bradycardia and hypothermia. increased cardiac vagal hyperactivity is thought to cause bradycardia. Criteria for hospital admission include a heart rate <40 beats/min, blood pressure <80/50 mm Hg, and temperature <36°C (97°F).
|
|
|
What is the risk of developing esophageal AC in a person w/ Barrett's esophagus?
|
<1%.
|
|
|
A 45-year-old male presents with a complaint of recent headaches. He has had four headaches this week, and his description indicates that they are moderate to severe, bilateral, frontal, and nonthrobbing. There is no associated aura. He has had similar episodes of recurring headachesin the past. What kind of headache can you eliminate from the differential.
|
Cluster headache, these are always unilateral. tension, sinus, migraine can all be bilateral.
|
|
|
for toenail fungal infections (onychomycosis), which therapy has the highest cure rate and long term resolution rate?
|
oral terbinfide. topicals don't work well in onychomycosis because infection is in the cells of the toenail.
|
|
|
What medications used in schizophrenia would cause weight gain and elevated fasting blood glucose?
|
second generation or atypical antipsychotics are associated with weight gain, elevated TG and type 2 DM. Olanzapine and clozapine are assoicated with highest risk.
|
|
|
A 40-year-old male with a 20-pack-year history of smoking is concerned about lung cancer. He denies any constitutional symptoms, or breathing or weight changes. You encourage him to quit smoking. Is there any test to order in this patient?
|
nope. patient at risk for cancer if though asx. No test/procedure is demonstrated will improve survival w/o cessation of smoking
|
|
|
40-year-old female p/w pain on inspiration and dyspnea x 2 hrs. She has no chronic medical problems, takes no medications, has not traveled, and has no history of trauma. PE: the patient is afebrile, has a heart rate of 90 beats/min and a respiratory rate of 20/min, and her lungs are clear to auscultation. The pain is worse in supine. Next test(s)?
|
CXR and EKG. could be pericarditis but r/o dyspnea caused by PNA, PE, pneumothorax.
|
|
|
anxious 62yo in ED c/o dyspnea and cough w/ blood sputum. denies cp/f. PE: +wheezing and rales. tachycardia and S3 gallop+. CXR: R pleura effusion and redistribution of blood to upper lobes. Best test to confirm dx?
|
BNP. consider HR w/ bronchospastic component. S3 gallop occurs in dialated LV and R-sided effusion, common in HR. BNP can differentiated b/w cardiac and pulmonary causes.
|
|
|
drug reported subjectively to help with symptoms of raynauds.
|
nifedipine.
|
|
|
Which drug should not be used during acute attack of gout.
|
Allopurinol decreases production of uric acid and is effective in reducing frequency of flare-ups but since fluctuating levels of uric acid can worsen inflammation during episode, not rec.
|
|
|
First line treatment for acute gouty attacks?
|
Corticosteroids such as prednisone. Can use colchcine (inhibit MT formation in WBC), NSAIDs (indomethacin) can also be used during acute attacks.
|
|
|
recommendation for treatment in postpartum period for asx/pain free mother who develop DVT during antepartum and was treated with LMWH.
|
risk of PE continues in postpartum period and may actually increase. continue LMWH for 6 more weeks! (could use warfarin post-partum too)
|
|
|
What drugs are approved for treatment of DM2 in children?
|
metformin and insulin are only two drugs approved for the kids
|
|
|
What sx or lab findings can help distinguish between pseudo and real seizure.
|
pseudoseizure: eye closure throughout event, h/o chronic pain syndrome or fibromyalgia.
Seizure: elevated prL, tongue biting, post-ictal confusion and focal neurologic signs |
|
|
A patient dying of cancer is suffering from pain in spite of his narcotic regimen. You increase his dosage of morphine, knowing it will probably hasten his death.
Which ethical principle are you following? |
double effect. used to justify medical treatment designed to relieve suffering when death is an unintended but foreseeable consequence. based on 1. doctor's motivation is to relieve suffering 2. treatment is appropriate for illness.
|
|
|
25 yo has 2+ protein on Udip x 3 visits. 24hr urine protein < 2g/24hr but 16hr collect increased v 8hr o/n collection. Next test?
|
None. people younger than 30 w/ <2g protein per day urine w/ normal Cr clearance should be tested for orthostatic proteinuria. Its a benign condition seen in 3-5% young adults. normal excretion when supine. No further tests necessary
|
|
|
50yo M p/t ED for syncopal episode. 30 min prior to episode, +Nausea the vomit. during second episode of vomit, blacked out for few seconds. No seizure reported. PMHx negative. PE normal. Next step?
|
EKG. If prodrume is 5s or less --> cardiac arrhythmia. If longer prodrome, nausea, vomiting, think VASOVAGAL which is a benign process. Recommended test is EKG, if normal, dysrhythmias not likely cause.
|
|
|
38 yo F w/ PMHx of seasonal allergies p/w sinus pain, nasal drainage and fever (102F) x 10days. Loratidine not helpful. Abx to prescribe?
|
Amoxicillin. rhinosinusitis - initiating antibiotic treatment in patients with symptoms persisting for 7–10 days that are not improving or worsening Amoxicillin should be the first-line agent, with azithromycin or trimethroprim/sulfamethoxazole recommended for penicillinallergic patients. .
|
|
|
A 27-year-old male was roughhousing with his children when he was accidentally struck in the left eye. He immediately felt pain in the eye, and over the next hour noted increased tearing,pain with blinking, increasing headache, and a foreign-body sensation. What injury do you suspect. What test should you order?
|
florescien light and cobalt blue filtered should reveal corneal abrasion. consult ophthalmology if edge of abrasion is grey or white (indicate infection). can provide in office topical anesthetics (not at home)
|
|
|
42 yo p/w abdominal cramps and diarrhea x 8years. Refractory to IBS treatment. MHx and ROS negative. Next step in eval?
|
serologic testing for celiac sprue. For chronic cramp + diarrhea, DDx: celiac sprue, IBS, microscopic and collagenous colitis, atypical crohn's.
|
|
|
treatment for mild BPH.
|
watch and wait! If PSA > 2.0ng/ml, 5-a-reductase inhibitors should be started (reduce size of prostate)
|
|
|
Most likely cause of hearing loss in otherwise healthy females ages 30-50?
|
otosclerosis
|
|
|
Women should be tested for human papillomavirus (HPV) DNA:
|
when a Pap smear shows ASC-US
|
|
|
inability to take four steps, either immediately after the injury or when being evaluated; localized tenderness of the navicular bone or the base of the fifth metatarsal; or localized tenderness at the posterior edge or tip of either malleolus are indications for what?
|
ottawa rules for radiograph of ankle
|
|
|
what would be the most appropriate empiric therapy for nursing home–acquired pneumonia in a patient with no other underlying disease?
|
levofloxcin. In the elderly, empiric therapy must cover Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and gram-negative bacteria. Levofloxacin is the best single agent for providing coverage against this spectrum of organisms.
|
|
|
55-year-old obese male with hypertension and daytime somnolence is found to have severe obstructive sleep apnea, with an apnea-hypopnea index of 32 on an overnight polysomnogram.
Which one of the following is considered to be first-line therapy for this patient's condition? |
CPAP. in individuals w/ cardiovascular disease
|
|
|
T/F: A patient’s condition does not need to be terminal or irreversible to allow the removal of life-sustaining therapy.
|
True.
|
|
|
which drug is most likely to be of benefit in patients with essential tremor of the hand?
|
propranolol and topiramate (anticonvulsant).
|
|
|
A 24-year-old African-American male presents with a history of several weeks of dyspnea, cough productive of bloody streaks, and malaise. His examination is normal except for bilateral facial nerve palsy. A CBC and urinalysis are normal. A chest radiograph reveals bilateral lymph node enlargement.This presentation is most consistent with:
|
sarcoidosis. Buzz words: noncaseating granulomas. Facial nerve palsy in < 5% of patients
|
|
|
What herbal supplement used for memory may have a negative interaction w/ aspirin.
|
ginko biloba associated with serious intracerebral bleeding. It can inhibit platelet aggregation.
|
|
|
What antibiotic is most appropriate to treat traveler's diarrhea in a 8 year old.
|
Azithromicin. traveler's diarrhea usually caused by E Coli, Campylobacter, shigella and salmonella. Cipro is effective but not to be used in kids.
|
|
|
Corticosteroid use, decreased BMI, vit D def and hypogonadism are all secondary causes of ________ in males.
|
osteoporosis
|
|
|
where is the preferred site for an emergency airway?
|
cricothyroid membrane, right below thyroid cartilage.
|
|
|
60 yo M c/o lightheadness x 3 months. EKG - RBBB and LA hemiblock. Next appropriate step?
|
cardiac event monitoring. patient is at risk for tachyarrhythmias and bradyarrhythmias. immediate hospitalization is not required at this time.
|
|
|
anterior neck tenderness, goiter and hx of sorethroat and fever 2 weeks ago. What else would support diagnosis of subacute granulomatous thyroiditis.
|
SGT is MCC of thyroid pain. free T is elevated but resolves. Differentiate from graves by RAIU (low v high in grave's)
|
|
|
+hawking's sign indicates...
|
impingement
|
|
|
what antidepressant will be best for reducing likelihood of sexual dysfunction
|
bupropion. lower rates v SSRI (esp parotoxine)
|
|
|
In a patient with hypertriglyceridemia, the National Cholesterol Education Program recommends that a reasonable goal for non-HDL cholesterol is no more than
|
30 mg/dL above the LDL-cholesterol level
|
|
|
4 wk old p/w 2wk hx of dyspnea, cough and poor feeding. PE: afebrile, nontoxic but conjunctivitis and rales. WBC - eosinophilia. etiologic agent
|
Chlamydia trachomatis. Chlaymydia pneumonia: CXR will show hyperinflation and diffuse interstitial infiltrates. common to nontoxic and afebrile
|
|
|
he most common identifiable cause of skin and soft-tissue infections presenting to metropolitan emergency departments is:
|
MRSA
|
|
|
What lab should be ordered before initiating treatment with metformin (Glucophage)?
|
serum creatinine. metformin is associated w/ lactic acidosis
|
|
|
What nutritional interventions should be recommended to accelerate pressure ulcer healing in the elderly?
|
adequate protein and caloric intake! increased vit C and zinc are unclear
|
|
|
The use of a corticosteroid inhaler in patients with stable chronic obstructive lung disease has been shown to:
|
increase risk of pneumonia. However, patients subjectively indicate that improves QOL and bronchitis exacerbations
|
|
|
what interventions have been shown to lessen mortality in COPD
|
smoking cessation and continuous oxygen
|
|
|
T/F: amiodarone can cause hypothyroidism
|
False. the drug is 37% iodine and a common source of iodine excess in the US. can increase production of TH and trigger thyroiditis to cause hyperthyroidism
|
|
|
A 20-year-old college wrestler is seen for an examination prior to the wrestling season. He tells you that some friends have told him he should start taking dehydroepiandrosterone (DHEA), and he asks for your advice.
|
doesno;t enhance performance or strength. While it is banned, its like androstenedione, both precursors to testosterone but actually increase serum estrogen and LH.
|
|
|
Treatment for acute paronychia (inoculation and swelling of nail fold 2/2 to local trauma)
|
topical abx, warm compress and if necessary I&D
|
|
|
best initial treatment for patellofemoral stress syndrome?
|
PT. this is often runner's knee or anterior knee pain.
|
|
|
what screening test is appropriate for routine postpartum visit in an uncomplicated NSVD
|
depression.
|
|
|
"Queen barb steals phen-phen and refuses greasy carbs chronically" - in mnemonic for:
|
p-450 inducers
|
|
|
preferred treatment for scabies?
|
permethrin, 5% and lindane.
|
|
|
best evidence of effectiveness for preventing fractures in postmenopausal women with osteoporosis?
|
alendronate
|
|
|
A 39-year-old female presents with lower abdominal/pelvic pain. On examination, with the patient in a supine position, you palpate the tender area of her abdomen. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies.
|
hematoma within abdominal wall musculature
|
