ABFM ITE Exam 2026/2027 Practice Questions & Answers | Family Medicine Study Guide |Exam study Material

ABFM ITE Exam 2026/2027 Practice Questions & Answers | Family Medicine Study Guide |Exam study Material 2026 / 2027 Academic Year Q: ABX ppx for ortho surgery Answer: Cephazolin Q: FEV1/FVC ratio for obstructive lung disease Answer: 0.7 Q: ACEIs/ARBs cause low or high K? Answer: High K Q: When is Tdap given in pregnancy? Answer: Between 27-36 weeks Q: What is the most common radiologic finding in early pulmonary sarcoidosis? Answer: bilateral hilar adenopathy Q: People with DM are more/less likely to develop adhesive capsulitis? Answer: more Q: AAP recommends starting checking BP at age ____ Answer: 3 years old Q: Which conditions are triptans contradicted in? Answer: Coronary artery disease Cerebrovascular disease Peripheral vascular disease Pt with uncontrolled or multiple CV risk factors Q: What is type 2 asthma? Answer: Includes allergic and eosinophilic asthma Type 2 inflammation is diagnosed by any of the following... - elevated eos in the blood or sputum - elevated fractional exhaled nitric oxide - need for oral corticosteroid maintenance therapy Q: When in pregnancy is intrahepatic cholestasis of pregnancy (ICP) typically seen? Answer: late second tri/3rd tri Q: Treatment for intrahepatic cholestasis of pregnancy (ICP)? Answer: ursodeoxycholic acid early delivery Q: According to the American Society for Anesthesiology, all patients who are having major surgery shouldb e offered pre-op labs including... Answer: CBC Renal function testing Q: What is the recommended treatment for metatarsal stress fractures? Answer: No weight bearing for a few days, possibly using a posterior splint -- walking boot or short cast -- rigid-soled shoe in 4-6 weeks Q: Next steps for proteinuria in children on dipstick? Answer: Confirm presence of proteinuria with a spot protein/creatinine ratio to r/o proteinuria Q: How to manage a pt who is traveling to a high-risk TB area? Answer: TB test or interferon-gamma release assay prior to leaving the US. If negative, repeat testing 8-10 weeks after returning. Q: Pt developed myopathy on statins and.... Answer: another CYP3A4 med... - Amiodarone - CCBs - some HIV meds - some anti-fungal meds Q: When is surgical release of a dupuytren's contracture indicated? Answer: When the metacarpophalangeal joint is 30* or smaller or with any contracture of the PIP Q: How to treat traveler's diarrhea? Answer: Azithromycin Q: What risk factors increase risk of mortality for PNA? Answer: - RR 30 - hypotension - confusion/disorientation - BUN 20 - 65 y/o - male sex - CHF or COPD Q: Pityriasis rosea in pregnancy is a/w... Answer: increased rate of spontaneous abortion in the first 15 wks gestation Q: What are indications for long-term PPI therapy? Answer: - Barrett esophagus - severe erosive esophagitis - eosinophilic esophagitis - pts at high risk for GI bleeding Q: Why do pt's with Crohn's disease develop diarrhea after ileal resection? Answer: D/t increased amounts of bile acid remaining in the stool. This affects colonic secretion and motility and various protein factors in the gut -- bile acid diarrhea Q: Pt with mild hemoptysis, next step... Answer: CXR - exertional dyspnea - chest pain - dizziness Q: T/F: Obesity is a significant risk factor for esophageal adenocarcinoma? Answer: True Q: What are symptoms of worsening aortic stenosis? Answer: Q: A1C diagnosis for T1DM? Answer: Need 2 A1C6.5 in the abscence of hyperglycemia Q: What organ system should be checked yearly for sarcoidosis? Answer: Occular - inflammation of eye can -- permanent impairment and is often asymptomatic Q: Ages for HIV screening? Answer: 15-65 y/o Q: Blood pressure management for pt with CKD + proteinuria? Answer: ACE/ARB + thiazide/CCB Q: Next step for pt with passive SI? Answer: Crisis planning (not a suicide prevention contract - that's not effective) Infants consuming less than ________ mL formula/day should be supplemented with vit D. Answer: 1,000mL How much vit D supplement should BFing infants get? Answer: 400 IU What Cobb angle (scoliosis) is at high-risk to progress and should be referred? Answer: 20+% CDC recommends prescribing naloxone when opioid dosage reaches ____ MME Answer: 50 What sacral dimples on newborns do not need further imaging? Answer: - no hair or other skin findings - small 0.5cm - 2.5cm from anal verge What is charcot neuroarthropathy? Answer: Statin + PAD? Statin shoudl be prescribed in PAD regardless of LDL cholesterol level inflammatory condition that occurs in obese pts w/ peripheral neuropathy and ultimately -- foot deformities (classic rocker-bottom fot) and resultant ulcerations and infections - easily mistaken for cellulitis What is the treatment for charcot neuroarthropathy? Answer: immobilization w/ total contact casting -- increases total surface area of contact to the entire lower extremity and distributes pressure away from foot What is the preferred treatment for preventing mountain sickness? Acetazolamide What is the preferred treatment for acute mountain sickness? Dexamethasone How long should dual antiplatelet therapy be for patients with acute coronary syndrome who are not high risk for bleeding? who are high risk for bleeding? Not: more than 1 year Are: 1 year (at least) What labs can be useful predictors of severity of pancreatitis? Those that reflect intravascular volume depletion - hct - BUN - Cr How to screen for DM in pts with hemoglobinopathies? Fructosamine What is the first step in managing delirium in end-of-life care after conservative measures have been tried? Antipsychotics - haloperidol - risperidone Which diabetic meds are associated with diabetic ketoacidosis? SGLT2 inhibitors (ex. dapagliflozin, empagliflozin) What are risk factors for intamate partner violence? - young age - belief in strict gender roles - having new friends - low incme - unplanned pregnancy What is a FABER test for? Sacroiliac joint disfunction How long do you treat provolked VTE with AC? 3 months What has been shown to decrease hospitalizations in pts with COPD? Written self-management plans Normal TSH range in pregnancy is higher/lower than normal non-pregnancy range lower How often should a breast cancer survivor have a history and physical? Every 3-6 months for the first 3 years. THEN every 6-12 months for the next 2 years THEN annually How often should breast cancer survivors get mammograms? MRI? mammogram: Yearly MRI: not recommended What are the Ottowa Knee rules? - Age /= 55 - isolated tenderness of the patella (no other bony tenderness) - tenderness of the fibular head - unable to flex knee to 90* - unable to bear weight both immediately and in ED (4 steps, limping OK) Tamsulosin promotes passage of ureteral stones that are ____ mm in diameter 5-10 Next step for migraine that won't respond to ibuprofen + triptan? Anti-emetics (metaclopramide, prochloperazine, promethazine) When to PO after pancreatitis? As soon as pt is able to tolerate! When is carotid stenting considered for asymptomatic patient? 70% occlusion what is the treatment of choice for eosinophilic eosophagitis? steroids applied to esophagus (oral suspension or oral spray) Which medications are a/w increased risk of osteoporosis? - antiepileptic drugs - long-term heparin - cyclosporin - tacrolimus - aromatase inhibitors - glucocorticoids - gonadotropin-releasing hormone agonists - thiazolidinediones - excessive levothyroxine - PPIs - SSRIs - medroxyprogesterone contraceptives - methotrexate - aluminum antacids Conditioner and head lice treatment? Do not combine - conditioner will decrease effectiveness of permethrin Besides permethrin, what other recommendations are made to treat lice? wash closing and bedding with hot water or expose them to a temperature 130*F for 5 minutes What characteristics of lung nodules are a/w malignancy? - nonsolid "ground glass" appearance - 6mm - non-calcified - size doubling between 1mo-1year - irregular/spiculated borders How much fluid to give in shock? at least 30cc/kg Which vaccine is rec'd to give early for pts with HIV and CD4 200? Shingles vaccine Management of a nondisplaced radial head fracture? breif immobilization (ex. 3 days), and early range-of-motion exercises to avoid decreased ROM. What are causes of low DLCO (difusing capacity of the lungs for carbon monoxide) with normal spirometry? - chronic PEs - HF - connective tissue disease with pulm involvement - pulmonary HTN Do patient's w/ artificial heart valves get ABX for dental procedures? Yes! - TOC: Amoxicillin - if allergic: clindamycin or azithromycin Primary vs. secondary vs. tertiary interventions? Primary: prevention that targets pts who are at risk of developing disease Secondary: targets pts who have developed asymptomatic disease and institutes treatment to prevent complictaions (ex: pap smears, screening for HTN/DM/HLD) Tertiary: pts with known disease with the goal of limiting/preventing future complications Which type of medication is responsible for 95% of medication-induced galactorrhea? SSRIs Which electrolyte abnormality are elderly pts taking carbamazepine especially at risk for? hyponatremia Next step for plaque psoriasis resistant to high-potency topical steroids? add topical calcipotriene (synthetic vitamin D3) Could also add topical tazarotene (do not use as monotherapy) For a patient with severe acute pancreatitis, along with IV fluids, what is recommended to shorten hospital stay? Continuous nasogastric enteral nutrition (not bolus feeding) Which question would be best to increase vaccine use: You have not yet received your shingles vaccine. May we give that to you before you leave? You have not yet received your shingles vaccine. We are preparing to administer that today. Do you have any questions? You have not yet received your shingles vaccine. We are preparing to administer that today. Do you have any questions? Presumptive approach is best Which question would be best to increase vaccine use: You have not yet received your shingles vaccine. May we give that to you before you leave? We have a vaccine prepared for you, and can give it to you after the visit. Do you have any questions? We have a vaccine prepared for you, and can give it to you after the visit. Do you have any questions? What is the annual failure rate of COCPs? 7% What is the tool used to diagnose delerium? Confusion Assessment Method (CAM) Screening guidelines for cholesterol according to the AAP? Lipid check in children 9-11 y/o and again between 17-21 Once you diagnose rheumatic fever what should be given? NSAIDS!! What accounts for a significant number of cases of FTT, crib death, and recurrent PNA in infants? GERD - recurrent PNA - low growth curve - family hx of SIDS - normocytic anemia Which vitamin D is recommended for screening for deficiency? to monitor? Screening: 25-hyrdroxyvitamin D Monitor: 1,25-dihydroxyvitamin D What contraception will improve hirsutism in PCOS? COCPs Why does H. Pylori require higher doses of levothyroxine in a patient with hypothyroidism? impaired absorption First line tx for uncomplicated UTI? Nitrofurantoin, TMP/SMX, Fosfomycin AC in older person with afib? Often benefits outweigh risk. Can use HASBLED score In addition to aspirin, a high-intensity statin, and sublingual nitroglycerin PRN, patients w/ chronic stable angina can be treated with... - beta blockers OR - CCBs AND/OR - long-acting nitrates (best in pts with bradycardia) Diameter of which atria/ventricle determines likelihood of pt in afib being successfully cardioverted? L atrium Target glucose control in sepsis? 180 What are the two types of functional dyspepsia? Epigastric Pain Syndrome Postprandial distress Syndrome Treatment for functional dyspepsia types? Epigastric pain syndrome: PPIs or H2 blockers Postprandial Distress Symptoms: motility agents (ex: metoclopramide) Management after treatment of uncomplicated MRSA bacteremia f/u blood cultures 2-4 days after initial cultures and as needed to ensure clearance What is the strongest indication for a patient with PEs to be treated with thrombolytic therapy? Hypotension (SBP 90 or DBP 60) For exclusively breastfed infants born before 37 weeks, iron supplement should be started when? 1 mo, and continued until 12 mos of age First line tx for fibromyalgia? - aerobic exercise - balanced diet - good keep hygiene - weight loss What is the recommended treatment for a childhood hemangioma after involution? Surgical excision When can laser therapy be used for infantile hemangiomas? to treat early lesions or residual telangiectasia TOC for arthritis pain in Lupus? Hydroxychloroquine TOC for severe lupus or lupus nephritis? Cyclosporine or Azathioprine What can lead to higher levels of NT-proBNP? - elevated Cr - low GFR - low albumin Higher BMI can make falsely LOW NT-proBNP When do kids get 2 vs. 3 doses of HPV? Kids 11-14 can get only 2 doses (6-12 mos apart) However, if the first two were 5 mos apart, will need a 3rd dose If pt with afib has a stemi, what is their INR goal if they are on warfarin? 2.0-3.0 If a pt with afib has a stemi, how long should they continue triple therapy (dual anti-platelet and anticoagulant)? As short as possible, and aspirin can be discontinued after 1-3 mos What do probiotics help with in children? - prevent antibiotic-associated diarrhea in children - reduce pain with IBS (but not diarrhea itself) - prevention of eczema and URIs (not asthma nor allergies) Rotavirus cannot be given after..... 14wks and 6 days of age When is rota vaccine given? 2, 4, 6 mos What type of colon polyps are most likely to -- cancer? Adenomatous, specifically VILLOUS What are factors used for calculating the pretest probability for PE? - elevated HR w/o hemoptysis - cancer - recent surgery/immobilization - previous thromboembolism - s/s of PE -- D-dimer What has the best evidence for treating acute low back pain? - NSAIDs - acetaminophen - muscle relaxants For patients /= 65 y/o, A1C goals are... 7-8% What meds reduce mortality in pts with HFrEF? - ACEIs/ARBs - BBs - aldosterone antagonists - isosorbide mononitrate/hydralazine - SGLt2 inhibitors What are the preferred agents for vasopressors? 1. norepinephrine (better in septic shock) 2. dopamine Injury with positive empty can? supraspinatus Positive Hawkins test meaning? Rotator cuff impingement syndrome What is the distinguishing symptom of dermatomyositis from other myopathies? Other symptoms? Distinguishing: Gattron's sign (non palpable macule over extensor surface of joints) Other symptoms: - dilated nail-fold capillaries - ragged, thickened cuticles Dx: polygonal papules lichen planus What are the 6 Ps of lichen plants? - pruritic - planar - polygonal - purple - papules - plaques On wrists, ankles, mucosa What is the treatment for a 5th metatarsal fracture in the foot (Jones fracture)? Active pt: Surgery No surgery: splint 3-5 days, then non-weight-bearing cast for 6 wks Management of simple, asymptomatic ovarian cyst? F/u ultrasound in 8-12 wks Management of ovarian cysts that are partially symptomatic, less simple features, 10cm, or longer than 12 wks? Referred for diagnostic removal Management of pts with ear drainage that have ventilation tubes in place? ABX ear drops (w/ or w/o corticosteroids) a pleural protein to serum protein ratio ___ or a pleural fluid LDH to serum LDH ratio ____ - exudative effusion 0.5 0.6 When might it be useful to get a coronary calcium score? when ASCVD is borderline or intermediate risk (5-20%) to help determine statin. If calcium score 100, start statin Recommendation for DEXA for a pt with bariatrics surgery? q2 years Dx: - unexplained proteinuria - peripheral neuropathy - enlargement of tongue - cardiomegaly - intestinal malabsorption - b/l carpal tunnel syndrome - orthostatic hypotension primary sarcoidosis 1st line med for depression in adolescents? fluoxetine Foot puncture wound through rubber sole, most common pathogen? Treatment? Pseudomonas Ciprofloxacin Treatment of salmonella gastroenteritis? supportive care - only ABX for kids that bacteremia Tx for early systemic Lyme disease? Corticosteroids Tx for facial nerve palsy of Lyme disease? Doxycycline or amoxicillin x14 days Tx of asymptomatic pt after a tick bite? single dose doxy or amoxicillin as PPx Radioactive iodine uptake in graves? toxic multi nodular goiter? high! Next step when parents decline vaccination for their kid? sign a vaccine refusal form Rx for new sensorineural hearing loss? oral corticosteroids (and referral to audiology) What is the first and best indicator for iron absorption? reticulocyte count TB skin induration cutoffs? 5mm: recent contact w/ TB, radiographic evidence of prior TB, HIV, immunosuppressed 10mm: others at increased risk 15mm: no known risks Screening for children with sickle cell? Ages 2-16 should get transcranial doppler ultrasouns Muscle for internal rotation of the shoulder? Subscapularis Muscles for external rotation of shoulder infraspinatus and tires minor What are characteristics of fetal alcohol syndrome? - camptodactyly (flexion deformity of fingers) - other flexion contractures - radioulnar synostosis - scoliosis - spinal malformations - many neurologic, behavioral, and CV abnormalities Tx of otitis media with effusion in child? supportive care, f/u in 3 mos What are pts w/ subclinical hypothyroidism at risk for? - Afib - HF - osteoporosis Management of somatic symptom disorder? CBT Frequent, scheduled office visits intensive behavioral intervention is best for... autism When do immediate release opioids hit peak effect? 1h after given Speeds test? Test for long-head of bicep tendon (proximal) only proven therapy for COPD + pulmonary HTN? o2 therapy (cannot use bosentan, nifedipine, sildenafil b/c will cause V/Q mismatch) Which meds reduce severity of OSA? diuretics Does smoking increase risk of OA? no! Most common cause of uncontrolled HTN? Medication nonadherence Absolute contraindications to T? - Breast cancer - prostate cancer - PSA 4 - nodules on rectal exam - polycythemia w/ HCT 54% Rome IV criteria for IBS - pain related to defecation - change in stool frequency - change in stool form Risk of antipsychotics in patients with dementia? Increased risk of mortality Management of stress fracture of proximal fifth metatarsal? Particularly prone to nonunion - should get an MRI What is vocal cord dysfunction? When vocal cords close when they should be open, typically during inspiration. - sudden, severe dyspnea with inspiratory stridor or wheeze - common in women ages 30-40 What is the first line tx for rheumatoid arthritis? methotrexate (or other nonbiological disease-modifying anti rheumatic drug) Next step for microhematuria (3 RBCs)? Cystoscopy first line tx for allergic rhinitis? intranasal corticosteroid When to avoid gadolinium contrast? If GFR 30 shockable rhythms? - vfib - vtach In pts with COPD, which med reduces hospitalizations? tiotropium (long-acting antimuscarinic) Noncaseating granuloma sarcoidosis Elevated angiotensin converting enzyme (ACE) often sarcoidosis (could also be TB or other things) What anticoagulant can you use in pregnancy? enoxaparin Most common cause of hirsutism in premenopausal women? PCOS (75-80% of cases) Management of corneal abrasion? small (/=4mm) -- NSAIDs Pre-op management of warfarin for pts getting surgery high risk (mechanical heart valves, stroke/TIA/VTE in last 3 mos, stenting in last 12 mos): bridging w/ low molecular weight heparin Low risk: d/c warfarin 5 days prior to surgery, restart 12-24h after surgery In PCOS, which medication increases likelihood of fertility? letrozole Tx: Rocky Mountain spotted fever doxycycline Second line for T2DM after metformin? SGLT2 When is A1C falsely low? anytime erythrocyte lifespan is decreased (ex: hemolytic anemia) When is A1C falsely increased? When conditions decrease erythropoiesis that therefore increase mean age of the RBC (ex. iron deficiency anemia, B12 deficiency) Most common causes of neonatal sepsis? 1. Group B strep 2. E. Coli most common cause of tinnitus? sensorineural hearing loss What medication reduces HA duration and severity in chronic tension-type HAs? amitryptiline TOC for alopecia areata? Intralesional corticosteroids Topical steroids are less effective For sepsis, how much fluid over how long? 30cc/kg over 3h What are worrisome signs of mallet finger? Inability to possibly extend, may indicate trapped tissues When should MRI of the breast be done? women at very high risk: genetic mutations, hx of breast irradiation, very high-risk family history What is mallet finger? injury to the distal extensor tendon of the finger at the DIP joint from forceful flexion of an extended DIP joint. Often from being struck by an object like a ball. Murmur in hypertrophic cardiomyopathy Systolic at LL sternal border If preload increases, will decrease murmur (laying down, squatting) If preload decreases, will increase murmur (valsalva) Tx of acute Bell's palsy corticosteroids + valacyclovir Diagnostic test for Cushing syndrome? 24h urine cortisol Tx: mild CAP in children amoxicillin Flu in pregnancy? Tamil within 48h of symptom onset Test for adrenal insufficiency? ACTH stimulation test What vitamin (besides D) can cause hypercalcemia? Vitamin A - causes bone resorption and hypercalcemia What does it mean for a pt to have macrocytic anemia iso reticulocyte count 2%? decreased RBC production (maybe d/t alcohol use or nutritional deficiency) Tx of pituitary adenomas 10mm? Tx with dopaminergic agent (ex. bromocriptine) - will lower prolactin and shrink adenoma Indications for ABX ppx for endocarditis? - prosthetic cardiac valves - previous infective endocarditis - unrepaired cyanotic congenital heart disease - repaired congenital defect w/ residual shunt - cardiac transplant w/ valve regurg d/t structurally abnormal valve AEs of long-term use of PPIs? - fractures - hypoMg - vit B12 deficiency - iron deficiency - acute interstitial nephritis -- CKD For colorectal screening, at what age is it recommended to have screening switch from standard to more individualized approach? 75-85 y/o S/S of cerebral palsy - increased muscle tone - cross-legged posturing - neck stiffness - hyperreflexia S/S of muscular dystrophy Head lag When should infants with improper eye coordination improve? 4-6 months - if not, refer Dx of influenza? Clinical dx! - rapid onset fever, nausea, sore throat, negative pulmonary findings When to treat influenza with tamiflu? High-risk pts - chronic lung disease - CV disease (including HTN) - renal disease - hepatic disease - hematologic disease - neurologic disease - age 65 y/o - children on long-term aspirin therapy - pregnant/postpartum women What is the most common cause of hypercalcemia? Primary hyperparathyroidism Which hypertension meds cause hypercalcemia? thiazide diuretics Rotator cuff injury in child, next step? Xray! Uncommon to have in children, but can be issue with growth plate When should internal tibial torsion in children be resolved? by 5 y/o - surgery if continues until 8 y/o Dx of Osgood-schlatter disease Apophysitis at the insertion of the patellar tendon at the tibial tubercule clinical diagnosis! Imaging is not needed rash from Lyme disease Erythema migrans What is meralgia paresthetica? compression of lateral femoral cutaneous nerve as it crosses under the inguinal ligament -- anterolateral hip pain and dysthesia MCC of skin and soft tissue infections in cities in the ED? MRSA When to recommend fibrates for patients? TG 1,000 When to treat osteoporosis? 10-year risk 20% or ^3 3% hip fracture What test has the highest negative predictive value to r/o celiac disease? genetic testing for HLA-DQ2 and HLA-DQ8 Which endocrine disorder is most commonly a/w long-term opioid use? hypogonadism What fluid is preferred for warming a patient? NS When to give DAPT after stroke? aspirin alone? DAPT: if mild, non-debilitating stroke aspirin alone: if major When to do cardiac screening for newborns? After 24h of life PE causes exudative or transudative effusion? exudative What is SMART therapy in asthma? Single maintenance and reliever therapy (SMART): combo of inhaled corticosteroid and long-acting bronchodilator Formoterol is the only med available in US recommended for SMART -- budesonide/formoterol T/F: patients with spinal stenosis can have poor balance true How do you test for obesity hypoventilation syndrome? Daytime PaCO2 In patients with polymyalgia rheumatica, which medication can be added to glucocorticoids to reduce the risk of relapse? methotrexate When should you image a soft tissue mass? If 5cm -- high risk for malignancy When do you do fluoride varnish for kids? when first tooth erupts, then twice yearly management of 5th metacarpal fracture (boxer's fracture) 40* volar angulation acceptable -- gutter splint What is filiform papillae or "hairy tongue" Causes furry appearance w/ hair-like projections that become colonized with bacteria and can take on a dark pigmentation. - more common in older patients, males - worse with tobacco and alcohol use, poor oral hygiene, low-fiber diet, hypo salivation, mouth breathing, immunosuppression - halitosis Management: increased fiber, regular tongue brushing with toothpaste or hydrogen peroxide Which medication improves composite outcome of hospitalization d/t HF or cardiovascular death in HFpEF? SGLT2 inhibitors Which medication decreases risk of contracting traveler's diarrhea? Bismuth subsalicylate When does Duchenne muscular dystrophy show up? usually not made until 4-5 y/o with gait abnormality - dx with CK in pts who are slow to walk - x-linked Thoughts about death for children ages 2-6? Often believe they are responsible for the death of a loved one T/F: SSRIs commonly cause hyponatremia in elderly true When starting ace inhibitors, ok to tolerate up to a ___% increase in baseline Cr 30% Tx for hot flashes in pts that cannot take estrogen and are already on SSRI/SNRI? Gabapentin (reduces 40-65%) -- clonidine (reduces 20-40%) Why is pseudoephedrine and phenylephrine bad in elderly patients? - elevates BP - elevates intraocular pressure - worsens urinary obstruction - adversely interacts with BBs, methyldopa, tricyclics, hypoglycemics, MAOIs Why are first generation antihistamines bad in elderly enhance anticholinergic and sedative meds After osteoporosis, what is the most common metabolic bone disorder? Paget disease (1-2% of the population) - most pts have only elevated all phos Only elevated alk phos -- normal GGT -- ? plain radiography of skull, tibia, pelvis to look for lytic lesions and cortical thickening (Paget disease) Colchicine and CAD Low-dose colchicine (0.5mg qD) FDA-approved for secondary prevention in patients with CAD (30% drop in CV events) Which IV med has the best evidence for reducing hospitalization for asthma? magnesium - bronchodilator effects that improve airway excitability and smooth muscle relaxation Tx of heat stroke immersion in cold water + fanning - cold IV fluids for old people How much does hospice increase life expectancy for pts with terminal cancer? 3 months When might pts need to be on warfarin rather than direct oral anticoags for afib? - moderate/severe mitral setnosis - mechanical heart valve Next step for uncomplicated reflux in infant? thickened feeds and/or switching to soy formula Risk factors for progression of latent -- active TB? - lung cancer - DM - alcoholism - recent contact w/ person w/ active Tb For carpal tunnel syndrome, which therapy has best evidence for delaying surgery? steroid injection For patients with renal failure being treated with epoetin alfa, what is the Hb goal? 10-12 At risk of cardiovascular evens /= 13.5 Screening guidelines for DM? 35-75 y/o adults who are overweight or obese Hip fracture should be operated on within ______ hours of injury 24-48h Test for pertussis? PCR What are the two SSRIs FDA approved for depression in children and adolescents? fluoxetine escitalopram Management of mild gallstone pancreatitis after feeling a little better? consider cholecystectomy during admission Which supplement increases risk of lung cancer in smokers? Beta-carotene Dx: pain in posteromedial foot and ankle posterior tibialis tendinopathy Dx: overuse lateral ankle pain Peroneal tendon injury Dx: pain over medial ankle ligament complex after acute injury involving eversion deltoid ligament sprain Next step for elevated serum Ca? PTH TOC for chlamydia doxycycline black widow spider bite Black, red hour glass marking - can cause muscle spasm + diaphoresis Tx: - mild: NSAIDs Sitagliptin medication class DPP4 inhibitor Tx duration for unprovoked DVT? indefinite What are homebound pts allowed to leave home for? - religious services - therapeutic/psychosocial tx at an adult day care program - outpatient dialysis/cancer tx Preferred imaging for appendicitis in adults? CT with IV contrast Alternative for bisphosphonates in pts who cannot tolerates? zoledronic acid (reduces vertebral and hip fracture risk) Teriparatide, raloxifene, calcitonin salmon (only reduce vertebral fracture risk) If N/V in pregnancy begins after ___ wks gestation, secondary causes are more likely to be present 9 wks Mcc of seizures in the elderly? stroke Pallidotomy + thalamotomy for Parkinson's disease Tx of SVT that does not respond to vagal maneuvers? adenosine cardioversion if does not work What antibiotics to avoid in pt on a statin? clarithromycin erythromycin What nasal spray should not be used more than 3 days? intranasal decongestants (aka phenylephrine) - will cause rebound congestion on drug withdrawal - when used for months, can -- rhinitis medicomentosa Tx of lesion suspicious of melanoma? elliptical excision (not shave) Best way to place a pregnant person 20 wks if spinal trauma? L lateral decubitus spinal trauma: supine with uterus deflected laterally Tx for osteopenia is indicated when 10-year risk of major factors reaches ___% 20% Which FQ should not be used to treat UTIs? Moxifloxacin What is the most common type of adverse event for hospitalized pts? Drug-related events Dx: complaints of discomfort w/ blurred vision and hx of striking steel Intraocular foreign body Tx of acute symptomatic urinary retention? urethral catheter x3 days In sensorineural hearing loss, the Weber test (on forehead) localizes to the good/bad ear? good ear In conductive hearing loss, the Weber test (on forehead) localizes to the good/bad ear? bad In conductive hearing loss is bone or air conduction better? boneair Pain relief tx for osteoporotic vertebral compression fracture? Salmon calcitonin (injectable or intranasal) Alzheimer's vs. normal aging? Alzheimer's: Normal aging: does not influence daily living, usually noticed by pt more than family member Most effective tx for head lice in children? Malathion - permethrin and pyrethrin are less effective Mild intermittent asthma sxs? daytime sxs no more than 2 days/wk nighttime sxs no more than 2 nights/mo Mild persistent asthma sxs Daytime symptoms 2 days/wk, less than once/day Nighttime symptoms 2 nights/mo Moderate persistent asthma sxs daytime symptoms daily nighttime symptoms 1 night/wk Most common stress fracture in kids? Tibial Which tocolytic med can cause respiratory depression? Mag sulfate - reflexes are usually lost first What is echinacea often used for? prophylactic for URI Management of toddler refusing to eat provide healthy foods for all meals and snacks, end meal if child refuses to eat What is the MCC of hearing loss in newborns Genetic disorders Tx for pregnant pt with recurrent miscarriages and +antiphospholipid antibody aspirin + heparin Dizziness + diplopia = peripheral/central vertigo central! needs workup! What is strabismus? Ocular misalignment diagnosed with the cover/uncover test - misaligned eye moves to fixate on a held object when opposite eye is covered -- eye drifts back to its original position when opposite eye is covered What is amblyopia? cortical visual impairment from abnormal eye development, often a result of strabismus What is esotropia? type of strabismus with an inward or nasal deviation of eye that would be evidenced by corneal light reflex lateral to normal position (medial eye drifting) What is exotropia? Type of strabismus w/ outward or lateral deviation of eye that would be evidenced by corneal light reflex medial to its normal position What is heterophoria? aka latent strabismus - does not cause eye deviation when both eyes are uncovered Hemolytic anemia: LDH: increased/decreased Haptoglobin: increased/decreased Indirect bilirubin: increased/decreased LDH: increased Haptoglobin: decreased Indirect bili: increased Dupuytren's contracture is a/w with what disease? DM If pt has CKD and needs contrast, how do we do it? Hydration w/ sodium-bicarb-containing fluids Management of acute ankle sprain? Semi-rigid brace that allows flexion and extension or soft lace-up brace Lifestyle recs for cirrhosis w/ ascites? - limit Na to 2,000mg - high-protein diet Is chondrocalcinosis c/w gout or pseudogout pseudogout - from calcium pyrophosphate deposition Tx for angina besides lifestyle mods, antihypertensives, statin, immediate release NG? BBs For patients with true B12 deficiency, what lab is most sensitive/specific? elevated methylmalonic acid (MMA) elevated homocysteine levels b/c b12 converts MMA -- succinyl coA b/c B12 converts homocysteine -- methionine Ureteral stones ____mm typically pass without intervention within 40 days 4mm Fluoride supplementation recommendations? starting at 6 mos for children whose primary water source is deficient in flouride Tx for mild COPD? LAMA (ex. tiotropium) Any child younger than ___ days old w/ a fever (even if nontoxic) should get sepsis workup 29 Yearly labs for pt with down syndrome? CBC with diff Serum iron, TIBC TSH Lipid panel For a patient with anorexia nervosa, what is the best indication of bone mineral density recovery? return of menses Differentiating features of Zika virus? Tropical regions no fever rash w/ severe pruritis + conjunctivitis Differentiating features of chikungunya virus? high fever debilitating joint pain Differentiating features of dengue virus? high fever headaches, pain behind eyes, nausea, vomiting, swollen glands, bone/joint/muscle pain, rash Differentiating features of west nile virus? fever headache tiredness vomiting, swollen lymph nodes Differentiating features of yellow fever backache, headache, N/V when can kids with hand foot mouth return to school? When afebrile, no drooling Excision vs rubber band for hemorrhoids Excision: thrombosed external hemorrhoid Rubber band: grade 1-3 internal hemorrhoid Henoch-Schonlein is IG____ mediated small vessel vasculitis A Vasculitis: - nonthrombocytopenic palpable purpura - colicky abdominal pain - arthritis Henoch-schonlein purpura Vasculitis: - conjunctival injection - mucosal erythema - rash - lymphadenopathy Kawasaki Vasculitis: - night sweats - fatigue - weight loss - myalgia - arthritis - later findings: HTN, skin lesions, cardiac disorders Takayasu arteritis Vasculitis: - weight loss + fatigue - later findings: respiratory problems, ophthalmologic lesions, neuropathies, glomerulonephritis, skin lesions Wegener's granulomatosis Vasculitis: - fatigue, fever, myalgias - skin lesions - GI symptoms (postprandial abdominal pain) - cardiac lesions Polyarteritis nodosa Best tx for childhood enuresis? bedwetting alarms When can kids with bacterial conjunctivitis go back to school? when treatment is started How much RhoGAM to give for gestational age /=12 wks? none! How much RhoGAM to give for gestational age 12-18 wks? 100mcg How much RhoGAM to give for gestational age /=18 wks? 300mcg Most common deficiency in the US? Iron Next step for low Hb in 1 y/o w/ negative lead? Iron supplement! (no need to check ferritin) Best predictor of bleeding risk? Bleeding hx How is scabies transmitted? Direct personal contact How to drain a felon? High lateral incision What is the mechanism of metformin? Inhibits gluconeogenesis in the liver What is the mechanism of sulfonylureas + meglitinides? Increase insulin release from pancreas What is the mechanism of thiazolidinediones? Sensitize peripheral tissues to insulin What is the nasal spray with best evidence for common cold? ipratropium nasal spray (atrovent) Pts with PCOS are at increased risk for what cancer? endometrial when to do hip ultrasound for baby not in breech? if first degree relative with hip dysplasia Does regional analgesia during labor increase risk of assisted delivery or c-section or both? assisted only Dx: - large ears - elongated face - macrocephaly - frontal bossing Fragile X Which type of kidney stones need acidification of the urine? Calcium phosphate + magnesium ammonium phosphate (struvite stones) What is non-invasive Test of choice for endometriosis? pelvic ultrasound Differentiating features of legionella pneumonia? systemic symptoms + GI and neurological symptoms -- respiratory symptoms develop later Bronchiectasis? Illness of bronchi and bronchioles that is obstructive and infectious - can be chronic - malodorous sputum - sometimes hemoptysis Unlike COPD and emphysema, has lots of sputum Duration of thromboprophylaxis after hip surgery? 35 days Proliferative vs. non-proliferative diabetic retinopathy? Non-prolif: - blot hemorrhages - cotton-wool spots - retinal vascular microaneurysms Prolif: - neovasacularization Treating BP 135/85 reduces risk of... - all cause mortality - CV mortality - risk of MI - risk of stroke Risk of MI If person is on O2, how to adjust if going on plane? Double flow rate For Crohn's disease, which med is most likely to induce remission? Corticosteroids (anti-TNF agents for moderate to severe Crohn's) What symptom is different in depression (that is not a part of grief)? Loss of interest in doing things NSAIDs and cirrhosis? NO!!! Avoid d/t risk of precipitating hepatorenal syndrome Dx: - rash with Wood's lamp "coral-red" Tx? Corynebacterium (erythrasma) Tx: erythromycin ointment Acute stress disorder vs. PTSD? Acute stress disorder: 3 days-1mo PTSD: 1 months ABI _____ indicates non-compressible arteries 1.4 Lung exposure? - pleural plaques - benign pleural effusion - malignant mesothelioma - ship worker Asbestos Lung exposure? - mining and manufacturing Berylliosis Lung exposure? - sand blasters - minors - people working with abrasives Silicosis Which is contraindicated in systolic HF? - carvedilol - digoxin - ramipril - spironolactone - verapamil Verapamil, d/t its negative inotropic effect, a/w worsening HF Which sulfonylurea is the most likely to cause hypoglycemia? glyburide First-line therapy for HTN in pregnancy? labetalol MCC of infectious endocarditis? staph aureus Tx for hypoactive sexual desire disorder in menstruating women? Topical testosterone (patch or gel foam) Fever after tx of syphilis? Garish-Herxheimer reaction - acute, transient febrile rxn that occurs w/in first few hours of tx for syphilis (peaks at 6-8h) Who is legally responsible for letting the pt know mammogram results? Facility performing mammogram What are Accountable Care Organizations (ACOs)? Introduced by Medicare and Medicaid services to encourage doctors, hospitals and other healthcare systems to deliver high-quality care and spend health dollars more wisely Next step when starting meds in kids for HTN besides labs? Echo! Tx for depression in pt on hospice w/ 2-3 wks to live? stimulants (ex. methylphenidate) When to give bleeding pts on warfarin vit K? INR 1.5 Which anti-hypertensive also helps with OSA? aldosterone blockers (ex. spironolactone) First line tx for diabetic neuropathy? Pregabalin or duloxetine MCC of infant wheezing while feeding? GERD Dx: herald patch Pityriasis rosea - starts with erythematous, scaly, oval patch a few cm in diameter -- a few days -- smaller patches on trunk and sometimes proximal extremities t/f: carbamazepine has increased risk of agranulocytosis? TRUE First line tx for Alzheimer's disease? Donepezil -- donepezil + memantine Lachman test tests for... ACL tear What do you do for a pt with DAPT getting bypass surgery? Stop clopidogrel or prasugrel 5 days prior, continue aspirin Average adult over 60 y/o can perform a timed up and go test in ____ seconds 10 seconds Congenital unscented testes? Refer between 6-12 mos Parvovirus B19 is associated with erythema ........ infectiosum MCC of fetal death after 20 wks gestation placental disease Tx or critically ill pt who has flu and bacterial pna tamiflu ceftriaxone azithro vanc Tx for bipolar disorder? Valproate For pts with multi vessel disease and DM and CAD, which is better: coronary bypass graft or angioplasty w/ stent? coronary bypass When is PCV23 recommended? How much RhoGAM to give for gestational age /=12 wks? Orthostatic BP Measurement Supine for 5 min Standing for 3 min What symptom is most commonly seen with delirium tremens Fever Oral med for rosacea Doxycycline Etiology of Diabetes Insipitus Deficiency in arginine vasopressin (ADH) Goal uric acid for pts with gout? 5-6 When should ABX time-out occur for inpatient 48h Breast cancer screening for trans females? In general, expert guidelines recommend starting breast cancer screening in transgender females at age 50 and after 5-10 years of feminizing hormone therapy Management of nondisplaced spiral fracture of the distal tibial shaft (toddler's fracture) Toddler's fractures can have subtle radiographic findings and may not be visible on initial radiographs, so repeat radiography to look for healing is appropriate. Standard treatment is immobilization of the affected leg What is a sesamoid fracture? Fracture of one of the two sesamoid bones of the first MTP joint of big toe - d/t overuse, sharp blow, or sudden dorsiflexion What test should you get in pt with lichen planus? Hepatitis C Antibody - pts with lichen planus have higher incidence of hep C Most effective emergency contraception? Copper IUD oral ulipristal What is a "sports hernia"? Not a true hernia, but a tearing of tissue fibers - symptoms similar, but no hernia on exam Extra ocular muscles LR6 SR4 O3 When to give rac epi for croup? If symptoms are moderate-severe in the ED, reduces immediate symptoms, but not later on. If mild -- dex Dx: BB-like pattern on CXR histoplasmosis Drug class: exenatide GLP-1 agonist Tx for maturity-onset diabetes of the young (MODY) Sulfonylureas!!! Form of DM in non obese young adults (under age of 30) who have preserved pancreatic B-cell function - positive C-peptides - strong family hx of DM - does not respond to metformin b/c B-cells work well AAA screening guidelines Males age 65-75 y/o who have ever smoked Anxiety screening in children Screening 8-18 y/o Breast cancer screening guidelines women 40-74 y/o mammo every 2 years Cervical cancer screening guidelines 21-29 y/o: every 3 years (cytology alone) 30-65 y/o: every 5 years (co test) Pts with PVC burden of 10% are at risk of... PVC-induced dilated cardiomyopathy - should perform an echo Dx: fungus in southwestern US - rash w/ erythema nodosum - intermittent fevers, night sweats - dry cough, weight loss, myalgias coccidiomycoses What medical conditions decrease responsiveness to warfarin and reduce INR? - hypothyroidism - visceral carcinoma - increased vitamin K intake - DM - HLD Exam finding with highest sensitivity for heart failure? 3rd heart sound ABX for diverticulitis amoz/clav or metro + FQ Colorectal cancer screening guidelines A: 50-75 y/o B: starting at 40 y/o Depression screening in adolescents? 12-18 y/o What week to screen for GDM? 24-28 wks If unsure about the diagnosis of pityriasis rosea, what else should you test for? Syphilis - the rash of secondary syphilis may be indistinguishable from pityriasis rosea on initial exam, when no herald patch is noted ITP vs TTP TTP: typically a/w anemia, neurologic changes, fever, renal failure ITP: common cause of isolated thrombocytopenia - otherwise normal labs, minimal systemic symptoms Common eye condition in Ankylosing spondylitis? Treatment? uveitis -- steroids! Alt tx for ear infection if amoxicillin allergy? 2nd or 3rd gen cephalosporin Most common depression symptom in elderly? somatic symptoms What type of EKG finding would indicate that you should do a pharmacologic stress test exercise? LBBB - makes EKG uninterpretable during exercise - is a/w transient positive defects in the anteroseptal and septal regions in the absence of a lesion w/in the LAD coronary artery. this -- false-positive tests and low specificity Hepatitis C screening recommendations All adults 18-79 y/o When to refer children for elevated BMI 95%ile 6+ y/o Lung cancer screening guidelines Adults 50-80 yo who have a 20 pack year smoking hx and currently smoke or have smoked in the last 15 years Low dose CT yearly Stop when pt has not smoked for 15 years Osteoporosis screening DEXA for women 65+ y/o DM screening all adults 35-70 y/o who are overweight or obese When do you repeat antibody testing for Rh negative women? between 24-28wks Vision screening in children At least once for children 3-5 years old Tx for extensive poison ivy? high dose steroids tapered over longer period (10-14 days) to prevent relapse Dx: back pain with morning stiffness that improves with physical activity? Ankylosing spondylitis Preop for RA patient Cervical spine imaging TOC for ICU delirium? atypical antipsychotics Which uterotonic medication for tx of PP hemorrhage should be avoided in pts with hypertension? Methylergonovine Which med for tx of postpartum hemorrhage is contraindicated in asthma? carboprost (hemabate) colonoscopy recommendations for pt with ulcerative colitis? 10 years after dx, then every 2-5 years Tramadol should be avoided in pts with... seizures COPD diagnosis is an FEV1/FVC ratio ___% of predicted 70% Best form of pessary? Ring pessary - space-occupying pessaries are a/w more vaginal discharge and irritation and do not allow for sexual intercourse Which NSAID is safest for pts that have had an MI? Naproxen Dx: - sudden painless loss of vision or distortion of vision - tortuous and dilated retinal veins Retinal vein occlusion What common meds can cause false positive test for opioids? - dextromethorphan - diphenhydramine - ibuprofen - fluroquinolones Which of the following does NOT improve with stretching? - hamstring pain - chronic neck pain - joint contractures - OA - rehab post knee replacement joint contractures When to treat high blood pressure after a stroke? If BP 220/120 Next step after XR for 3 y/o with acute hip pain and not bearing weight? CBC + ESR (before US of hip) What is Plan-do-check-act? a cycle of continuous QI Imaging if c/f pancreatitis? Ultrasound Transudative: cancer vs. PE? Cancer has low glucose Screening for HCC in pts with cirrhosis? US q6 mos BP goals when managing hypertensive emergency? First hour: lower by no more than 25% Next 2-6 hours: lowered to 160/100 Next 24-48h: slowly lowered to normal Supplementation of vitamin D for low vitamin D? no clear guidelines or benefit in healthy person What are predictors of poor response to psychotherapy in adolescents with major depressive disorder? - presence of family conflict - severe depression - low global functioning on assessment - high scores on suicidality measures - coexisting anxiety - distorted thought patterns - feelings of hopelessness Indications for urgent dialysis in AKI? Uremic complications: - encephalopathy - neuropathy - pericarditis In addition to bisphosphonates, Ca, and vit D, what else helps improve bone density in pts with thalassemia and osteoporosis? Zinc! Also... - K 6.5 - Pulm edema not responsive to diuretics - negligible UOP 6h - UOP 200cc over 24h Dx: RAIU with areas of increased and decreased uptake? Toxic multinodular goiter Statin + _____ developed myopathy? - amlodipine - empagliflozin - hydrochlorothiazide - losartan - metformin amlodipine - both use CYP3A4 enzyme Dx: 2.5cm pruritic, erythematous, oval macule on leg after Bactrim. Fixed Drug eruption What will improve adherence for pts with DM to get their eye exams teleretinal screening in the primary care office Dx: vision with patchy peripheral vision blurring glaucoma What is photodermatitis? Inflammation and/or discoloration of the skin caused by contact w/ specific plants followed by exposure to sunlight. - limes are common USPSTF recommends lung cancer screening begin at age _____ y/o for pts with ____ -pack-year smoking hx 50 y/o 20 pack-year Adding which of the following reduces all-cause mortality in pts w/ CAD who are on aspirin? - clopidogrel - colchicine - icosapent ethyl - isosorbide mononitrate - rivaroxaban Rivaroxaban Decreases cardiac events: icosapent ethyl, colchicine What should be monitored in SLE? - anti-double stranded DNA - complement levels - ESR, CRP - WBC, platelet - Cr, GFR - proteinuria (UA with microscopic exam), b/c of lupus nephritis Anti-citrullinated Ab is a/w... RA Workup for hemoptysis: CXR -- negative -- ??? CT After a passive exposure to cannabis, UDS can be positive for ________ up to 24h TOC for diverticulitis if requiring ABX? Amox/clav OR Metro + FQ PVC burden 10% -- ??? Echo! - at risk for dilated cardiomyopathy What surveillance should be performed for pts who have undergone neck irradiation? Carotid U/S q10 years - carotid artery disease is more common in these pts THS q5 years Initial Tx for COPD? long-acting beta agonist OR long-acting muscarinic antagonist All pts w/ Kawasaki disease should undergo what imaging to evaluate for coronary artery dilation and aneurysm? Echo Elevated thyroid peroxidase levels are seen in.... Hashimoto How long to screen for postpartum depression Up until 1 year after giving birth Tx for CAP? amoxicillin OR doxy Tx for CAP with comorbidity? FQ only (levo or moxi) OR amox/clav OR cephalosporin + doxy/macrolide which test has the highest negative predictive value for celiac? HLA-DQ2 or HLA-DQ8 In hypothermia, why NS LR? NS b/c hypothermic pts cannot metabolize lactate Dx for obesity hypoventilation syndrome awake PaCO2 Alteplase after stroke is most effective when given within ____ hours of stroke symptoms 4.5h Thrombectomy for stroke should ideally be performed within ____ hours, but can be up to _____ hours 6h 24h First line for OSA CPAP surgery Which of the following commonly causes hyponatremia in the elderly? - amlodipine - amoxicillin - atorvastatin - escitalopram - spiro escitalopram - SSRIs are a common cause of hyponatremia in the elderly With initiating ACEi, ok to tolerate a Cr increase up to ____ % 30% Which of the following is most-likely to have long-lasting cure with steroid injection? - adhesive capsulitis - de quervain tenosynovitis - lateral epicondylitis - OA - subacromial impingement syndrome de quervain tenosynovitis How do you differentiate thalassemia from iron deficiency anemia Thalassemia: - low RDW - elevated retics - normal or slightly elevated RBCs - slightly elevated ferritin - nucleated RBCs on peripheral smear Does increased sensitivity increase or decrease over diagnosis? increases - means we might catch earlier diseases that are benign or we don't treat yet Treatment of hot flashes after HRT and SSRI/SNRI? Gabapentin clonidine When to pick warfarin for afib over DOAC? Mod/severe mitral stenosis or mechanical heart valve First-line for long-term relief of anginal symptoms? Beta-blockers Can add on CCBs next THEN long-acting nitrates or ranolazine If Weber test lateralizes to the good ear...? sensorineural hearing loss GOLD criteria GOLD 1: FEV1 /= 80 GOLD 2: 50-80% GOLD 3: 30-50 GOLD 4: 30 Differentiating features of zika virus - no fever - rash with severe pruritis - conjunctivitis Tx for chlamydia? doxy 100mg BID x7 days (NOT one day tx) Tx of mild alcohol withdrawal with low-risk for seizure/complication gabapentin or carbamazepine Tx for distal radius buckle fracture cock-up wrist splint Preferred imaging for suspected appendicitis in an adult CT with IV con IV contrast is safe in pts with GFR /= ______ 30mL/min Keeping BP 135/85 decreases risk of... MI For pts with CAP and resolution in 7 days, is f/u CXR needed no When would f/u CXR be needed after CAP? - suspicion for possible mass or lymphadenopathy weakness in multiple places in shoulder -- MRI (adhesive capsulitis = stiffness) Which of the following is a predictor of poor response to psychotherapy? - high global functioning - hypersomnia - inappropriate guilt - presence of family conflict Family conflict Tx of mild hidradenitis suppurativa Topical clindamycin Tx of acute vaginal bleeding? Hemodynamically stable: IV tranexamic acid Unstable: IV conjugated estrogen What meds increase resolution of nonalcoholic steatohepatitis (MASLD)? Pioglitazone (may cause weight gain and avoid in HF) What does LASIK treat? Myopia (near-sidedness) - not age-related presbyopia first-line tx for osteoporosis alendronate or zolendronic acid Which med for overactive bladder is ok to use in elderly? mirabegron (beta-adrenergic agonists) Tx of pts at very high fracture risk (T-score -3%, fax 4.5%, multiple fractures, fracture within 12 mos) Parathyroid hormone analogue (aka teriparatide) x2 years Dextromethorphan + SSRIs Can increase risk of Serotonin syndrome Exclusive BFing for 6 mos.... - higher infant HDL - lower risk of atopic dermatitis - lower maternal endometrial cancer risk lower risk of atopic dermatitis When for med vs. high-intensity statin ASCVD: 10-20% -- med ASCVD 20% -- high Adrenal incidentaloma next step 1cm: cortisol secretion testing 2-4cm: imaging with CT or MRI Tx for scaphoid fracture (tenderness over snuff box) Thumb spica Infertility w/ endometriosis, next step? laparoscopy -- will dx and treat Greatest risk for AAA? smoking Children under ____ months should be kept out of direct sunlight 6 months Tx of DVT in pt with antiphospholipid syndrome? warfarin Hypocalcemia symptoms tetany paresthesias extrapyramidal symptoms seizures Testing for early HIV? Viral load - will take 3-7 wks for Ab TOC for fibromyalgia? pregabalin amitryptiline duloxetine milnacipran (SNRI) jaundice after cholecystectomy? choledocolithiasis does a bilingual household delay speech? NO! noninflected wounds can be closed within up to ____ hours 18h (24h for head wounds) Biggest risk factor for speech delay? Male sex!! ahahaha Proximal fracture of which metatarsal is at highest risk for non-union 5th exercise in old folks reduces rate of falls or falls requiring hospital falls alone How to tx frostbite rewarm with water Causes of greater trochanteric (lateral) pain syndrome? glut med tendinopathy or tearing iliotibial band friction Initial test for low platelets? smear Next step after tx of UTI in child 24 mos? renal and bladder U/S How to calculate relative risk? Risk ratio Risk:risk For sickle cell disease, acute drop in Hb with pain over LUQ? Splenic sequestration - acute pain crisis does not have a drop in Hb usually Female pattern hair loss TOC? Topical minoxidil -- topical minoxidil + spironolactone - spiro on its own does not work low dose CT screening for 50-80 y/o who have quit within the last 15 yrs w/ 20 pack year Test name: spelling world backwards attention Test name: count backward by 7s attention test name: draw clock face executive function Tx for post-inflammatory hyperpigmentation Hydroquinone, fluocinolone/hydroquinone/tretinoin, azelaic acid Next step for fever of unknown origin after labs and CXR? PET/CT Vitamin deficiency that affects taste? B3 (niacin) What medication is best for pituitary adenomas? Carbergoline bromocriptine Tx of buckle fracture (distal radial fracture)? Short period of immobilization with splint ocular finding c/w glaucoma? Elevated cup:disc ratio What OTC md can help with IBS? Peppermint oil When should pts get DEXA early? - parental hx of hip fx - smoking - high alcohol consumption - low body weight Keeping SBP ____ decreases dementia risk 130 ADHD med while BFing? methylphenidate Negative FAST exam -- next step? Additional imaging to confirm no blood influenza prophylaxis in care facility vaccinate all exposed regardless of vaccination status how long to cervical cancer screen for high-grade lesion for 25 years after treatment Aortic valve replacement if EF ____ % 50% Tx of large local reaction to insect sting? oral prednisone recommendations for stopping multiple benzos? switch both to 1 long-acting benzo then taper what impairs swallowing of solids and liquids - achalasia - eosinophilic esophagitis - esophageal cancer - esophageal stricture - schatzki ring achalasia CAP antibiotic that causes VF Azithromycin Clinical manifestation of amyotrophic lateral sclerosis Asymmetric leg weakness - The arrhythmia results from prolongation of the QT interval and is also more common in patients with a prior cardiac history. Anti-DM medications for weight loss GLP1 receptor agonists e.g. Exenatide SGLT-2 inhibitor e.g. Canagliflozin Screening test with greatest potential for over diagnosis PSA Opioid to avoid in palliative patient with severe hepatic dysfunction Methadone - It is metabolized and cleared by the liver, and should therefore not be used in patients with severe hepatic impairment. It is, however, a reasonable option for patients with severe renal impairment. Lung cancer screening with low dose CT Chest annually Adults 55-80yo with 30 pack year history and currently smoking or quit within last 15 years NOAC with reversal agent Dabigatran Reduces alcoholism but creating an acute ethanol sensitivity Disulfiram Antidepressant to be avoided in the elderly Paroxetine (associated with more anticholinergic effects) SSRIs SNRIs, atypical antipsychotics may be added for resistant depression Age group between which American Academy of Pediatrics recommends administration of an autism-specific screening tool 18-24 months old Most common neurological complication of Paget's disease of the bone Most common cardiac complication of Lyme disease Heart blocks Examination finding of those with bacterial vaginosis Vaginal pH 4.5 (normal vaginal pH should be acidic) Most common cause of medication-related adverse events across health care settings in the United States Antibiotics Screening for asymptomatic carotid artery stenosis Not recommended In anaphylaxis, which drug is most likely helpful in preventing the need for intubation? Barrett's oesophagus with no dysplasia Positive family history of colorectal cancer Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age or two first-degree relatives diagnosed at any age should be advised to start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. Most common cause of hearing loss in newborns Genetic inheritance Lab findings in Von Willebrand disease U.S. federal labor law requires companies with 50 employees to provide which benefits for employees who are nursing mothers Influenza vaccination in those with potential egg allergy All currently available influenza vaccines, with the exceptions of recombinant and cell-culture-based inactivated influenza vaccines, are prepared using embryonated egg culture and can potentially provoke allergic and anaphylactic reactions. For those who report that they can eat lightly cooked scrambled eggs, vaccination can proceed without precaution or observation. Those who have experienced only hives can also receive any influenza vaccine appropriate for their age and health status. People who have