AMCB Board Review (NM717) PRIMARY CARE Exam Questions With Correct Answers

Metronidazole big take aways - Answer Used to treat BV, Trich, PID, etc Taken PO or PV SE: GI (take with food), HA, mild leukopenia or neutropenia (prolonged high doses, seizures ( prolonged high doses), urine darker, metallic taste STOP ALCOHOL UNTIL 48hrs AFTER avoid with hx of kidney or liver problems considered safe in pregnancy, iffy with breastfeeding Fluconazole big take aways - Answer Used for yeast/fungal infections CYP450 interactions b/c it works by inhibiting fungal CYP450 Can cause HA, GI Avoid with hx of heart arrhythmia, liver/kidney disease lots of drug interactions Can use in pregnancy and lactation but ideally topical Acylcovir big take aways - Answer Used to treat herpes genitalia/simplex/zoster, and varicella crosses placenta and enters breastmilk most of metabolism is in liver and excretion in urine inhibits viral DNA sythesis Does not cure latent herpes virus SE: n/v, diarrhea, HA, skin rash, acute renal failure (rare with PO) Can use in pregnancy and lactation Take with full glass of water **Valacyclovir: prodrug Famciclovir: prodrug, both of these have better bioavailability than acylclovir Alendronate take aways - Answer Bisphosphonate used for prevention and treatment of osteoporosis 3-6 months till max absorption Dont take with food, coffee, calcium (wait 2hrs), or orange juice it inhibits the activity of osteoclasts, which reduces bone resportion SE: GI problems, esophageal ulcers/erosions, hypocalcemia, osteonecrosis of the jaw, Need to stay upright x30min after taking it avoid with renal impairment, hypocalcemia Take in the morning with 8oz of water, no other drinks, foods, meds for 30-60min Oxybutynin take aways - Answer Antimuscarinic Anticholinergic Used for overactive bladder Can cause anticholinergic SE: dry mouth, blurred vision, constipation, tachycardia, urinary retention, drowsiness, impaired sweating, confusion Drug interactions with CYP3A4 inhibitors Take with full glass of water, can take with or without food, caution with overheating Caution with uncontrolled narrow-angle glaucoma, gastric or urinary retention, esophageal disease, liver/kidney disease, heart disease, HTN, older adults Atorvastatin take aways - Answer 1st line treatment for reduction of LDL decreases cholesterol production in the liver and increases LDL reuptake in liver. AE: muscle pain, rhabdomyolysis: if they have severe muscle pain or weakness, or dark colored urine check creatinine kinase levels GI: abdominal pain, constipation, diarrhea, nausea Lots of drug interactions, including warfarin, digoxin, and CYP3A4 inhibitors Contraindicated in pregnancy or with liver disease Tamoxifen take aways - Answer Selective Estrogen Receptor Modulator (SERM) Used to treat and prevent estrogen receptor positive breast cancer primarily excreted in feces AE: VTE, endometrial cancer, hot flashes, nausea, vaginal dryness, menstrual irregularities, weight gain, bone loss if premenopausal Pitocin Take Aways - Answer Onset: 3-4min, steady state in 30-40min, half life in 6-10min IV: subsides in 1 hr after d/c IM: duration of action for 2-3hrs minimally crosses placenta Risk for water intoxication Nitrous Take aways - Answer 50/50 nitrous and O2 crosses placenta but rapidly eliminated mostly breathed out can cause N/V, megaloblastic anemia with low B12 Betamethasone take aways - Answer promotion of fetal lung maturity two 12mg doses 24hrs apart if <34weeks AND first course was >7-14 days ago can give single rescue course Magnesium Sulfate take aways - Answer Anticonvulsant seizure prophylaxis with (pre)eeclampsia fetal neuroprotection if anticipating <32 week birth short term (<48h) tocolytic Usually IV: loading dose 4-6g in 100mL over 20-30min, then maintenance 2g/hr x 12-24hrs can cause flushing, palpitations, warmth, lethargy, muscle weakness, dizziness, n/v, respiratory deproession pulmonary edema DONT USE WITH CALCIUM CHANNEL BLOCKERS DONT USE >5-7 days MONITOR FOR TOXICITY (reversed with calcium gluconate) RhoGAM take aways - Answer Give IM. Effective for 12 weeks after administration doses: 50mcg and 300mcg Give at 26-28 weeks and postpartum ideally postpone live vaccines until 12 weeks after giving it OLDCARTS - Answer Onset, Location, Duration, Character, Aggravating/Associated factors, Relieving factors, Temporal factors (timing), Severity HEADSS - Answer Home Education Activities Drugs Sex Suicide (topics to cover with adolescents) Components of menstrual history - Answer menarche, regularity, frequency, duration, amount of bleeding, LMP, pads/tampons/douching, PMS/PMDD, dysmenorrhea, perimenopausal symptoms, age at menopause, use of hormone therapy, postmenopausal bleeding Components of sexual history - Answer age at first intercourse (consentual/nonconsentual) Hx of sexual abuse or assault sexual orientation gender identity Current sexual relationships: frequency of sex, satisfaction or concerns with sexual relationship, dyspareunia, orgasmic or libido problems STI risk assessmentL # of lifetime partners and # in past 3 months, types of sexual contact (vaginal , oral, anal), condoms/barriers, previous STI history, injection drugs or partner with injection drug history, sex with alcohol/drugs, HIV testing current and future desire for pregnancy contraceptives : current and historical, what works(s)/side effects, etc BMI - Answer <18.5 = underweight 18.5-24.9= normal 25-29.9= overweight 30-39.9= obesity 40+= extreme obesity Malignant Melanoma ABCDEs - Answer Asymmetry Borders Irregular Color: blue/black or variegated Diameter >6mm Elevation Normal lymph nodes - Answer less than <1cm in size, nontender, mobile, soft, discrete presbyopia - Answer impaired near vision myopia - Answer impaired far vision Eye Exam: Opacity of lens suggests: - Answer cataracts Eye Exam: dysconjugate gaze suggests: - Answer diseases, injuries, or lesions affecting CN III, IV, VI Eye Exam: nystagmus suggests: - Answer cerebellar system disorders, vestibular disorders, drug toxicity Eye Exam: Lid Lag suggests: - Answer exopthalmos, hyperthyroidism Eye Exam: papilledema (swelling of optic nerve) suggests - Answer Increased intracranial pressure Eye Exam: AV nicking suggests: - Answer HTN (Arteriovenous nicking, also known as AV nicking, is the phenomenon where, on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing.) Eye Exam: Retinal hemorrhage and exudates suggests: - Answer diabetes, HTN Weber Test - Answer Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard. Tests for lateralization of sound through bone conduction