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ABFM IN TRAINING EXAM PEARLS |
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Pre-exposure prophylaxis (PrEP), what meds, and what do you have check first? ANSWER: Emtricitabine/tenofovir gotta check Hep B first
- apparently they kill hep B too, so if you suddenly stop the med, then reactivated hep B can lead to liver disease entry to balloon time for PCI! ANSWER: 120 minutes time limit from onset of MI to balloon time ANSWER: should get it done w/in 12 hours Absolute contraindications to Fibrinolysis ANSWER: Previous hemorrhage stroke
Previous ischemic stroke (4.5hrs-3months prior) Suspected aortic dissection Active bleeding (except menstruation) BP >180/110 (severe hypertension) Streptokinase 6 months prior acute cholecystitis ANSWER: Acute inflammation of the gallbladder wall Patient with pulmonary HTN due to left heart failure, can they have vasodilators (PDE5?) ANSWER: NO! can make things worse
- maximize heart failure treatment! Sever's Diseaese ANSWER: Calcaneal apophysitis, also called Sever's disease, is a common cause of heel pain in young athletes, especially those who participate in basketball, soccer, track, and other sports that involve running. Typically the heel apophysis closes by age
- Treatment options include activity modification, the use of ice packs and/or moist heat, stretching, analgesics, and orthotic devices. The use of therapeutic ultrasound on the active bone growth plates in children is contraindicated. in pressure ulcers what solutions to avoid, and what to use!
when to refer patient with CKD to nephrology ANSWER: Current guidelines recommend referral to a nephrologist if a patient's renal disease is either of unknown etiology, is deteriorating quickly (eGFR decreasing by >5 mL/min/1.73 m2 per year), or is severe. Thresholds used to define severe chronic kidney disease include an eGFR <30 mL/min/1.73 m2, a urine albumin to creatinine ratio >300 g/mg, persistent acidosis or potassium imbalance, non-iron deficiency anemia with a hemoglobin level <10 g/dL, and evidence of secondary hyperparathyroidism. Causes of peripheral neuropathy ANSWER: common treatable causes of peripheral neuropathy, which include diabetes mellitus, hypothyroidism, and nutritional deficiencies. Additional causes of peripheral neuropathy include chronic liver disease and renal disease. It is important to consider medications as a possible cause, including amiodarone, digoxin, nitrofurantoin, and statins. Excessive alcohol use is another important consideration. In addition think MGUS, and Multiple Myeloma Failure rates of contraception ANSWER: The annual failure rate of combined oral contraceptive pills with typical use is 9%. Typical failure rates for other contraceptive methods are 0.2% for the levonorgestrel IUD, 6% for injectable progestin, 18% for male condoms, and 22% for the withdrawal method.
mental status exam for acute changes like delerium ANSWER: Confusion Assessment Method (CAM) to diagnose adult ADHD, symptoms must be present before what age? ANSWER: Age 12 Complications of GERD in infants ANSWER: Gastroesophageal reflux accounts for a significant number of cases of failure to thrive, crib death, and recurrent pneumonia. Features of gastroesophageal reflux include a history of recurrent pneumonia, a low growth curve, a family history of sudden infant death syndrome, and normocytic anemia. coining "sickness leaving body" ANSWER: it's a south asian thing, kids have multiple red welts and superficial abrasions scattered on chest and upper back thyroid replacement in the setting of gastritis ANSWER: need to increase by 30% because gastritis decreases absorption of thyroid. ex: h. pylori, treat h.pylori to negate this effect cubital tunnel syndrome ANSWER: irritation, compression, and entrapment of the ulnar nerve
ANSWER: ciprofloxacin, 500 mg orally one time; azithromycin, 500 mg orally one time; ceftriaxone, 250 mg intramuscularly one time; or rifampin, 600 mg orally twice daily for 2 days. Treatment should begin as soon as possible after exposure but no later than 14 days. Dermatomyositis ANSWER: chronic systemic immunological disease involving inflammation of the skin, connective tissue, and muscles distinct dermatologic findings, including Gottron's sign (nonpalpable macules over the extensor surface of joints). Patients may also have dilated nail-fold capillaries and ragged, thickened cuticles. jones fracture ANSWER: The treatment plan for this type of fracture needs to account for the activity level of the patient. It has been shown that active patients have shorter healing times and return to activity sooner with surgical management. A competitive dancer would be best managed with surgery. If the nonsurgical option is chosen the patient is given an initial posterior splint and followed up in 3-5 days, then placed in a short non- weight-bearing cast for 6 weeks, at which time a repeat radiograph is taken. If the radiograph shows healing, the patient can return to gradual weight bearing. If the radiograph does not show proper healing, then the period of non-weight bearing is extended.
what do asplenic patients do if they have fever and get in to see doctor for eval in 2 hours? ANSWER: Amoxicillin, levofloxacin, and moxifloxacin should be taken by asplenic patients with a new onset of fever if they cannot get to a medical facility within 2 hours for evaluation. Fever should be reported immediately due to the lifelong significant risk of sepsis. Unless otherwise contraindicated, asplenic patients should receive annual influenza immunization. Pneumococcal polysaccharide vaccine (PPSV23) should be given twice, with the second dose given 5 years after the first. chronic urticaria, what do you do if antihistamines don't work? ANSWER: add H2 blockers (doxepin can be used off label, blocks antihistamine receptors) steroids UV therapy 2nd line therapies what can you use for sensoneural hearing loss short term to reduce long term sequelae ANSWER: Prednisone! greatest improvement in hearing tends to occur in the first 2 weeks, corticosteroid treatment should be started immediately. The recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10-14 days. if patient has shellfish allergy, do you wait or give steroids and epi for IV contrast? ANSWER: NO! There is no correlation! Just do the damn CT!
ANSWER: Rapidly moving the pt from a sitting position to the supine position with the head turned 45 degrees to the Right. After waiting apx. 20-30 sec, the pt is returned to the sitting position. If no Nystagmus is observed, the procedure is then repeated on the Left side. preferred antidepressant in older patients ANSWER: Escitalopram (lexapro) herbal supplement with highest risk of drug interactions? ANSWER: St. John's Wort inducer of CYP3A4 and P-glycoprotein synthesis. Concurrent use of St. John's wort with drugs that are metabolized with these systems should be avoided. These include cyclosporine, warfarin, theophylline, and oral contraceptives. why recombinant zoster vaccine (shingrix) over live zoster vaccine (zostavax) ANSWER: better efficacy Peak effect of opioids ANSWER: oral 1 hr IM - 10 min Subq- 20 - 30 min
when to start O2 on pts with COPD? ANSWER: when PaO2 < 60 antihypertensives that help with HTN associated with OSA ANSWER: diuretics - but spironolactone does the best job highest cure rate for basal cell carcinoma? ANSWER: Moh's surgery patients who no depression but have alcohol use disorder, what med is the best? ANSWER: Acamprosate, zofran also may help only use SSRI / SNRI if co-existing depression Pseudofolliculitis barbae ANSWER: a chronic inflammatory form of folliculitis known as "razor bumps" resembling folliculitis papules and pustules; generally accepted to be caused by ingrown hair use electric clippers, less drama Olecronon Bursitis ANSWER: Chronic bursitis is due to repetitive microtrauma, and the olecranon is the most common location. Patients typically have minimal pain, no history of injury, no
what med has proven benefit for chronic tension headaches? ANSWER: TCAs! Try Amitryptyline! who should get MRI of breast? ANSWER: Women with very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history. Women who had chest radiation therapy during childhood or adolescence, generally for Hodgkin's disease, are at an extremely high risk for breast cancer. Allergic bronchopulmonary aspergillosis ANSWER: affects 1%-12% of immunocompetent patients with asthma and is important to consider in patients with recurrent exacerbations because it can cause permanent lung damage if it is undetected and untreated. The symptoms alone are insufficient for a diagnosis, but this clinical presentation should prompt consideration of the diagnosis, and some of the symptoms and findings noted are included in the diagnostic criteria. The major diagnostic criteria include the presence of asthma or cystic fibrosis and immediate skin reactivity to Aspergillus antigens, peripheral eosinophilia, transient pulmonary infiltrates or opacities, central bronchiectasis on a chest radiograph or CT, serum precipitating antibodies to Aspergillus fumigatus, and elevated Aspergillus IgE- and/or IgG-specific antibodies. leading cause of cancer death in men?
ANSWER: lung cancer leading cause of cancer death in women? ANSWER: lung cancer what med can you use with buprenorphine to reduce stress related opiod cravings and increase abstinence? ANSWER: Clonidine diagnosis of cushing syndrome ANSWER: - 24 hour urine cortisol
- After diagnosing, could get adrenal CT looking for adenoma, but not until high cortisol is established. Suspect with:
- DM
- HTN
- central obesity
- hypokalemia
- proximal m weakness
- edema dexamethasone suppression test has no place in dx anymore!
when melatonin and doxepin fail for insomnia, what can you use next? ANSWER: gotta try one of those Z drugs - Eszopiclone (lunesta) - among the Z-drugs only eszopiclone provides an early peak onset and a long half-life, with a 1-hour approximate time to peak and a 6-hour half-life when pharmacologic treatment for osteoperosis / osteopenia ANSWER: The National Osteoporosis Foundation recommends pharmacologic treatment when a DXA scan reveals a T-score <-2.5 (the cutoff for a diagnosis of osteoporosis), or when the T-score falls between - 1.0 and - 2.5 (the diagnosis criterion for osteopenia) and the 1 0 - year risk of a major fracture reaches 20%. The T-score of - 2.0 places this patient in the "osteopenic" range. A 10-year probability of a hip fracture >3% is also an indication for treatment. treatment of papulopustular rosacea ANSWER: doxycycline diarrhea occurring after ileal resection due to chrohns disease often caused by? ANSWER: increased bile acid in stool (bile acid diarrhea - BAD); tx with cholecystarmine alzheimer's medication with increased risk of bradycardia
ANSWER: Donepezil (aricept) patient on valproic acid comes in with altered mental status, why? ANSWER: Valproic acid causes of hyperammonia - have to treat with lactulose Psychogenic tremor ANSWER: abrupt onset, spontaneous remission, changing characteristics, and extinction with distraction. when should you taper antipsychotics on geriatric patients ANSWER: when sxs are in remission for > 3 months, taper w/ goal of stopping only thing approved for traveler's diarrhea ANSWER: hand wash frequently short course of azithromycin in case she develops it ptyriasis rosea and pregnancy risk ANSWER: increased risk of spontaneous abortion in 1st 15 weeks for pregnancy!! This is a benign disease EXCEPT IN PREGNANCY IT'S NOT!!!! annual screening for what in patients with sarcoidosis? ANSWER: annual eye exam; can be asx, and can lead to vision loss
what med used to prevent steroid induced osteoperosis? ANSWER: Bisphosphonates! when to do allergy testing? ANSWER: persistent sinus infections, allergic rhinitis, and poorly controlled asthma for insect stings is indicated only following systemic/anaphylactic or large local reactions, not with limited localized reactions most sensitive and specific test for genital herpes? ANSWER: PCR
- NOT TZANK GOD IT's NOT HERPES who has the highest prevalence of syphilis ANSWER: men who have sex with men what can you use to diagnose diabetes in sickle cell anemia instead of A1c since it falsely lowers A1c? ANSWER: Fructosamine who gets AV nodal ablation in afib ANSWER: those refractory to medical therapy
who gets emergent cardioversion in A fib? ANSWER: people who are hemodynamically unstable TSH in pregnancy ANSWER: ok so this is confusion but bear with me... normally due to higher effective circulating volume in pregnancy, you actually need to increase your levothyroxine during pregnancy. Check it every trimester and you will need to increase anywhere between 20- 50 % during prengnancy HOWEVER especially in the 1st trimester: elevated b HCG can cause TSH like activity! TSH and HCG share an alpha subunit so high levels of b HCG can actually activate thyroid hormone. This causes an increase in T4 WHICH LOWERS TSH DUE TO NEGATIVE FEEDBACK!! I mean WTF!!! So you give people more thyroid medication when they're pregnant, but actually their TSH is inappropriately lower anyways! So GOAL: keep TSH < 3 in pregnancy, and check every trimester! solar lentigines
