Family Medicine Board review questions

Most sensitive test for ACL tear?

Lachman test

What is a non-stress test?

assessment of fetal well being in the antepartum period - First check the FHR. A normal FHR has a baseline between 110 and 160 beats per minute with variability of 6 to 25 beats per minute. - Next, determine whether the strip is 'reactive' or not. A neurologically intact and healthy fetus should have two heart rate accelerations of at least 15 beats per minute over at least 15 seconds in a 20-minute period, which is called a 'reactive' strip. Non-reassuring Fetal Status: A baseline fetal heart rate of 170 beats per minute is defined as tachycardia, and would be cause for concern. Many problems could cause fetal tachycardia, including maternal fever or infection and fetal anemia or hypoxia. Minimal (5 or less beats per minute), absent, or marked (greater than 20 beats per minute) variability of the fetal heart rate. Reassuring Fetal Status: Moderate variability (6 to 20 beats per minute). A subjective report of active fetal movement. A "reactive" strip showing two heart rate accelerations (of at least 15 seconds with a peak of at least 15 beats per minute above the baseline) in a 20-minute period.

What is the primary treatment for symptomatic mitral valve prolapse

b-blockers

What is pyogenic tenosynovitis?

bacterial infection of synovial sheath present with flexed, swollen finger with pain with passive extension tenderness to palpation from tip of finger to palm early treatment (first 48 hrs) - antibiotics and splinting later stages - surgical drainage and antibiotics

What is obesity hypoventilation syndrome?

1. obese (BMI >30 kg/m2) 2. sleep apnea 3. chronic daytime hypoxia/CO2 retention increased risk for respiratory failure/death treat w/ CPAP/BiPAP

When should teriparatide be initiated?

1. severe osteoporosis 2. multiple osteoporosis risk factors 3. failure of bisphosphonate therapy - therapy limited to 2 years - contraindicated in pts with history of bone malignancy, paget disease, hypercalcemia, previous treatment with skeletal radiation

What is subclinical hypothyroidism?

1. slightly elvated TSH 2. normal levels of thyroid hormone

Signs of primary hyperaldosteronism, and diagnosis?

1. uncontrollable blood pressure (more common in women) 2. weakness (or asymptomatic) 3. hypokalemia morning plasma aldosterone/renin ratio (ratio 20 or more, and aldosterone level is 15 ng/dL)

Contraindications to Mirena (levonorgestrel intrauterine system)

1. uterine anomalies 2. postpartum endometritis 3. untreated cervicitis 4. current pelvic inflammatory disease

Signs of polymyalgia rheumatic?

1. white women of european ancestry 2. > age 50 3. nml - elevated ESR 4. fever, night sweats, depression, fatigue, malaise, anorexia, weight loss 5. corticosteroid treatment (48-72 hour dramatic response)

What is the risk factors for altitude illness

1. young age 2. residence at a low altitude 3. rapid ascent 3. strenuous exertion 4. previous history of altitude illness

Platelet transfusion threshold?

10,000

What is ulcerated, pearly nodule with rolled border on sun exposed skin typical of

Basal cell carcinoma

What does a thyroid panel show of someone with euthyroid sick syndrome?

abnormal TSH, Normal T4 patient has no symptoms of thyroid dz but are acutely ill w/ some critical illness

Two doses of varicella vaccine are recommended for?

all children unless they are immunocompromised (they would not be then)

What medication could be used in diabetes treatment in patient with CKD?

glipizide

What are ranson's criteria? - admission criteria - GA LAW

glucose >200 mg/dL Age >55 y LDH >350 AST >250 WBC >16,000

What is the most common cause of erythema multiforme?

herpes simplex virus

What risks are increased in vacuum assisted delivery versus forceps delivery?

higher rates of neonatal cephalhematoma + retinal hemorrhage however has: 1. less maternal soft tissue trauma

What is the symptomatic treatment of chronic venous insufficiency (supplement)?

horse chestnut seed extract

What is the most common abnormality with refeeding syndrome?

hypophosphatemia

What is exenatide?

incretin mimetic GLP-1 agonist - DM drug - may lose weight on it

What is the mainstay of treatment for mild-moderate allergic rhinitis?

intranasal corticosteroids

Which ashtma medication should only be used as additive therapy, and not monotherapy?

long-acting B2 agonists (bc of risk of asthma exacerbation or asthma-related death)

If pretest probability is low, mod, or high for DVT based on wells, what should be done?

low - d-dimer - if high d-dimer, then do compression u/s mod/high (>/= 2 on wells) - go straight to compression u/s - if positive start anticoag (heparin then warfarin or rivaroxaban/apixaban)

What is the appropriate diet for recurrent calcium oxalate stones?

low-sodium, restricted protein diet with increased fluid intake - oxalate restriction: spinach, chocolate, tea, nuts potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate

Which cancer causes the most cancer-related deaths in the US?

lung

What is macroglossia assd with?

macrogloss = enlarged tongue - found in: 1. Amyloidosis 2. Endocrine disturbance (acromegaly, cretinism) 3. tumor (hemangioma, lymphangioma) 4. Down syndrome or other developmental conditions

What is femoral neuropathy?

mononeuropathy assd w/ DM, as well as secondary to a number of conditions that are common in diabetics and not to the diabetes itself

Slipped capital femoral epiphysis?

most common hip disorder between the ages of 8 and 15 and is more common in boys and overweight or obese children. It presents with limping and pain, and limited internal rotation of the hip is noted on physical examination.

how can rhinitis (allergic vs nonallergic) be differentiated

nonallergic - more so nasal congestion + post nasal drainage, erythematous nasal mucosa allergic - more eye symptoms, watery rhinorrhea, earlier onset of age, bale bluish nasal mucosa

What causes molluscum contagiosum?

poxvirus

What is actinic keratosis?

precursor lesion to squamous cell carcinoma

Most common cause of geriatric hearing loss? What type of hearing loss?

presbycusis - most difficulty hearing HIGH frequency sounds such as consonants

Signs of malaria?

prodrome of delirium/erratic behavior - unarousable coma folowing generalized convulsions, fever, lack of FND (diffuse, symmetric encephalopathy)

gram negative rods implicated in cystic fibrosis related pneumonia?

pseudomonas aeruginosa burkholderia cepacia complex stenotrophomonas maltophilia

Treatment of Malaria ?

quinidine gluconate

Rapid replacement of thyroid hormone in someone with h/o of CAD can lead to what?

rapid replacement of TH increases the metabolic rate, myocardial oxygen demand - can lead to complications of CAD --> atrial fibrillation, angina, myocardial infarction

What is keratoacanthoma?

rapidly growing "volcanolike" nodule with central keratotic plug - may regress - typically removed as squamous clel carcinoma

What is cutaneous erythrasma?

secondary cutaneous bactrial (Cornyebacterium minutissimum) over underlying intertrigo presents as small reddish-brown macules that may coalesce into larger patches with sharp borders treat w/ oral/topical erythromycin

What is a hypertensive emergency?

severe BP elevations >180/120 mmHg complicated by evidence of impending or worsening target organ dysfunction

Is pain relieved by sitting in spinal stenosis or herniated disk

spinal stenosis - pain relieved by sitting herniated disk - pain releieved by standing

gram positive cocci in chains?

strep pneumo

Evidence of active labor?

strong regular contractions every three to five minutes and cervical dilation of more than 4-5 cm in the setting of cntractions

What medication can be used for post surgery urinary retention

tamsulosin (alpha-blocker)

What is chronic paronychia?

tenderness, erythema, swelling, and retraction of the proximal nail fold >6 wks assd w/ chronic immersion in water, soaps/detergents, use of certain systemic drugs (antiretrovirals, retinoids), finger sucking topical corticosteroid cream

Management of HTN in person w/ h/o previous stroke?

thiazide diuretic / ACE inhibitor combination

A painful thrombosed external hemorrhoid diagnosed within the first 24 hours after occurrence is ideally treated by:

thrombectomy under local anesthesia (external = painful w/ somatic innervation)

What is apraxia?

transmission disturbance on the output side, which interferes w/ skilled movements

What are the features of patellofemoral pain syndrome?

1. anterior knee pain 2. exacerbated by going up or down stairs or running in hilly terrain 3. adolescent girls 4. assd w/ inadequate hib abductor strength 5. rehab can help

What is the recommended therapy for those with drug-eluting stent to prevent stent thrombosis?

Aspirin, 162-325 mg/day PLUS clopidogrel BOTH FOR 12 months

Treatment of Bartonella henselae?

Azithromycin (cat-scratch dz)

Gram positive cocci in clusters?

staph aureus

When is asthma not well controlled?

'rule of twos' 1. asthma is not well-controlled if they have had symptoms where they had to use a beta-agonist for symptom relief more than twice per week 3. had 2 or more nocturnal awakenings due to asthma symptoms in the past month 4. two or more exacerbations requiring systemic corticosteroids in the past year

how is the diagnosis of mono made?

- positive heterophile antibody (Monospot) test (false negative during the first week is common so don't rule out with negative test) - atypical lymphocytosis - transiethepatitis

What is the treatment for PE?

-initial treatment with LMWH, unfractionated heparin, or fondaparinux for AT LEAST 5 days - stopped if the INR has been >/= 2 for at least 24 hours - Warfarin is given concomitantly for at least 5 days

What is the treatment for WPW?

1. Procainamide 2. Amiodarone

preliminary evaluation for crohn's disease?

1. WBC count 2. platelet count 3. potassium level 4. erythrocyte sedimentation rate

What are the possible treatments for altitude sickness?

1. acetazolamide (prophylaxis - contains sulfa) 2. dexamethasone (prophylaxis and treatment)

What substances are commonly implicated in interstitial nephritis?

1. antibiotics (penicillins, cephalosporins, sulfonamides) treat w/ corticosteroids

Treatment for nursing hoome-acquired pneumonia?

1. antipseudomonal cephalosporin - such as cefepime or ceftazidime and 1 of: 2. carbapenem such as imipenem or meropenm 3. extended spectrum b-lactam/b-lactamase inhibitor - (pip/tazo) 4. fluoroquinolone - such as levofloxacin or ciprofloxacin 5. aminoglycoside - gentamicin, tobramycin, amikacin PLUS anti-MRSA ie vancomycin or linezolid

What is the first line therapy for urinary urge incontinence?

1. behavioral - pelvic muscle contractions 2. anticholinergic therapy

Pertusis phases?

1. catarrhal stage prodromal phase: 1-2 wks; looks like viral URI progressing to severe cough after 2 wk 2. Paroxysmal cough --> can lead to fracture of ribs or vomiting (7-10 days) 3. convalescent stage

CV changes in aging?

1. decreased cardiac output 2. decreased maximum heart rate 3. decreased stroke volume 4. increased systolic/diastolic BP Respiratory changes - increase in residual lung volume, decrease in vital capacity

what is the triad of infxous mono?

1. fever 2. cervical lymphadenopathy (posterior or diffuse) 3. pharyngitis

What is the centor criteria for strep?

1. fever by history 2. tender anterior cervical lymphadenopathy 3. tonsillar exudates 4. absence of cough 0-1 = no testing for strep 2-3 - rapid strep antigen test 4 - empiric oral penicillin or amoxicillin

Signs of multiple myeloma end organ damage?

1. hypercalcemia 2. Renal Failure 3. Anemia 4. Skeletal lesions MM signs - presence of M protein, monoclonal plasma cells, both

Side effects of omeprazole?

1. increased risk of CAP (community acquired pneumonia) 2. increased risk of C. difficile colitis 3. decrease absorption of B12 4. decrease calcium absorption --> increased risk of hip fracture

Aspirin recommendation?

1. men 45-79 y/o 2. women - aspirin for women 55-79 y/o

Empiric coverage for neonatal sepsis suspicion? most common causes of neonatal sepsis?

Ampicillin and Cefotaxime 1. Group B Strep 2. E.Coli

Pneumococcal vaccine recommendations

Both the CDC and the American Academy of Family Physicians recommend that all adults over the age of 65 receive a single dose of pneumococcal polysaccharide vaccine. Immunization before the age of 65 is recommended for certain subgroups of adults, including institutionalized individuals over the age of 50; those with chronic cardiac or pulmonary disease, diabetes mellitus, anatomic asplenia, chronic liver disease, or kidney failure; and health-care workers. It is recommended that those receiving the vaccine before the age of 65 receive an additional dose at age 65 or 5 years after the first dose, whichever is later.

bilateral nipple pain with and between feedings after initial soreness has resolved in breastfeeding women

Candida

What is sitagliptin?

DPP-IV inhibitor (ie inhibits the enzyme responsible for the breakdown of the incretins GLP-1 and GIP) (Januvia)

What is exenatide (incretin mimetic that stimulates insulin secretion in a glucose-dependent fashion) - slows gastric emptying - promotes satiety

GLP1 Agonist incretin mimetic that stimulates insulin secretion in a glucose-dependent fashion - slows gastric emptying - promotes satiety

Which ulcer is more likely to cause malignancy - in the duodenum or the gastric?

Gsatric - thus it is essential in diagnosis of gastric ulcers to perform biopsy to rule out malignancy

What is the most common cause of chronic gastritis?

H.pylori infection (over 80%) can also be caused by: 1. autoimmune gastritis --> chronic atrophic gastritis (antiparietal and antiintrinsic factor antibodies)

What is thyroiditis?

Inflammatory or destructive (can be subacute, acute, or chronic) ie thyroid can recover 1. period of hyperthyroidism (transient) 2. acute; period of hypothyroidism; chronic - leads to persistent hypothyroidism in thyroidits, the thyroid is NOT MAKING any thyroid, just releasing premade thyroid, ie transient hyperthyroidism

What is the wells criteria?

ONE point for: 1. previous DVT 2. Active cancer 3. recent immob. 4. recent bedridden >3 days 5. localized tenderness along vein 6. swollen leg 7. calf swelling >3cm compared to other leg 8. pitting edema 9. collateral superficial nonvaricose veins 10. alternate diagnosis more likely (-2 pts) DVT IS LIKELY IF >/= 2 points

prsentation of erthyema toxicum neonatorum?

Rash on face, trunk, proximal extremities Macules, papules, and pustules that are 2-3 mm in diameter palms and soles spared pustular smear = numerous eosinophils

sudden infant death syndrome VS deliberate suffocation

SIDS - most common cause of death in first 6 months of life (peak incidience 2-4 months) - there may be evidence of 'terminal activity' such as clenched fists, serosanguineous, blood-tinged, or mucoid discharge from mouth/nose - lividity/mottling in dependent areas deliberate suffocation: infant age older tahn 6 mo, previous similar sibling deaths, simultaneous twin deaths, evidence of pulmonary hemorrhage - recurrent apnea, cyanosis

When should a trial of labor occur with concerns over baby's size

The American Congress of Obstetricians and Gynecologists (ACOG) recommends consideration of cesarean delivery without a trial of labor if the estimated fetal weight is 4500 g in a mother with diabetes mellitus, or 5000 g in the absence of diabetes.

What is pioglitazone?

a TZD (thiazolidinedione) - reduces insulin resistance - mechanism: Activation of PPAR-Gamma

most likely cause of the following symptoms 1. frequent abdominal pain 2. nonbloody diarrhea 3. 20 lb weight loss 4. chronic intensely pruritic vesicular rash

celiac sprue (autoimmune d/o) inflammation of small bowel wall, blunting of villi (villous atrophy), resultant malabsorption serum IgA tissue transglutaminase antibodies (TTG) dermatitis herpetiformis

What is the hepatojugular reflux?

check for right sided HF, place pressure on the liver and see if there is increased JVD

What is the classic presentation of intussuception

children under the age of 2 years - paroxysms of colicky abdominal pain - mass palpable in 2/3 of patients

Treatment for diverticulitis?

ciprofloxacin + metronidazole

What is acarbose?

competitive inhibitor of alpha-glucosidases (enzymes that break down complex carbohydrates into monosaccharides)

How can you diagnose giardiasis?

cysts/trophozites in the stool

Treatment of symptomatic (ie HF) atrial flutter?

electrical cardioversion

What ksin lesion is common in systemic sarcoidosis?

erythema nodosum also skin papules or subcutaneous nodules

What causes hypocalcemia in pancreatitis?

fat saponification in acute pancreatitis

Initial management of hypercalcemia of malignancy?

fluid replacement with normal saline

What is the treatment for ethylene glycol poisoning?

fomepizole

What is nursemaid's elbow?

forcing the elbow into extension radial head slips out of annular ligament

Signs of giardiasis?

foul-smelling, soft, or loose stools; foul-smelling flatus; belching; marked abdominal distention; and the virtual absence of mucus or blood in the stool

What is the krukenberg tumor?

gastric cancer metastasis to the ovary