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Classic |etiology |for |DVT |and |PE |- |correct |answer |✔-- |prolonged |immobilization |(bed |rest, |travel)
-- |surgery |w/in |last | 4 |weeks
-- |malignancy
-- |pregnancy |or |early |post-partum |(as |much |as | 6 |wks |post-partum)
Best |Dx |test |for |pulmonary |embolism |- |correct |answer |✔Helical |CT
Most |common |EKG |finding |in |PE |- |correct |answer |✔sinus |tachycardia
-- |through |commonly |s1Q3T3 |(S |wave |in |Lead-1, |Q |wave |and |inverted |T |in |lead |III) |is |more |often |found |in |PE |but |NOT |THE |MOST |COMMON
Next |step |in |Dxof |PTX? |VHY |- |correct |answer |✔PA |Chest |XR |during |Max |exhalation
Next |step |in |mgmt |of |suspected |PTX? |VHY |- |correct |answer |✔Needle |decompression
The |most |common |complications |of |Influenza-- |HY |- |correct |answer |✔-- |otitis |media |(10-50%)
-- |Strep |pneumonia |(2-3% |of |outpatient |and |14% |inpatient)
-- |Bronchitis
Less |common;
-- |aseptic |meningitis
-- |guillan-barre
-- |febrile |Sz
Rare:
-- |myositis
-- |myocarditis
Centor |criteria |for |strep |pharyngitis- |HY |- |correct |answer |✔-- |if |score |is |>/=2 |in |children |or |>3/= |in |adults |--> |perform |rapid |antigen |test
has |good |negative |predictive |value
-- |this |means |it |is |useful |in |figuring |out |which |pts |likely |DO |NOT |have |strep |throat
The |most |likely |diagnosis |in |a |child |between |18 |months |and | 3 |years |of |age |presenting |with |asymmetric |intoeing, |a |forward-facing |patella, |and |*no |foot
|deformity. |* |- |correct |answer |✔Internal |tibial |torsion
-- |Metatarsus |adductus |("pigeon |toe") |is |the |most |common |congenital |foot |deformity |that |causes |intoeing |
-- |present |prior |to | 18 |months |of |age. |The |presence |or |absence |of |a |foot |deformity |will |help |differentiate |the |two. |
painless, |white |area |on |lateral |surface |of |the |tongue |in |an
|immunocompromised |pts |are |most |likely |due |to? |- |correct |answer |✔Oral |hairy |leukoplakia |caused |by |EBV
Suture |lines |of |skull-- |look |up |metopic |sutures |- |correct |answer |✔
Premature |and |abnormal |fusion |of |one |or |more |suture |lines |that |result |in
|abnornal |head |shape |in |infants |- |correct |answer |✔Craniosynostosis
-- |can |be |idiopathic |or |due |to |hyperT4, |hypoPO4, |HyperPTH
-- |can |also |result |in |increase |in |ICP |with |abnormal |development |of |facial |bones, |strabismus, |and |hearing |impairment
Pre-requisite |for |obtaining |fasting |lipids |-- |HY |- |correct |answer |✔-- |valid |only |if |a |patient |refrains |from |consuming |calories |for | 12 |hours |as |well |as |avoiding |alcohol |for | 24 |hours |prior |to |sample |collection. |
-- |Fasting |lipid |profiles |must |be |repeated |for |patients |who |do |not |adhere |to |these |guidelines.
Most |appropriate |next |step |in |mgmt |of |a |newborn |suspected |of |having
|hemolytic |disease |of |the |newborn? |- |correct |answer |✔Direct |Coombs' |test
"Dig |Effect" |on |EKG |- |correct |answer |✔Downward |scooping |of |ST |segment |and |inverted |T-waves
Reticulocyte |count |in |different |conditions |seen |in |Sickle |cell |disease? |- |correct
|answer |✔-- |Normal |count: |indicates |splenic |sequestration
-- |elevated: |hyperhemolytic |
-- |low |value; |aplastic |anemia
MCV |is |commonly |increased |in |which |conditions? |- |correct |answer |✔-- |B |and |folate |deficiency
-- |Liver |disease |
-- |Alcoholism |(these |ppl |have |chronically |low |B9)
Common |Encapsulated |Organisms |- |correct |answer |✔S. |pneumo
H. |influenzae
N |eisseria |meningitidis
Ecoli
Salmonella
Klebsiella
S. |galactiae
MCV |is |commonly |unaffected |in |which |conditions? |- |correct |answer |✔-- |initial |stage |of |Fe |def
-- |anemia |of |chronic |disease |and |renal |disease
-- |hemolytic |anemia |(sickle |cell)
MCV |is |commonly |DECREASED |in |which |conditions? |- |correct |answer |✔-- |Fe- def |anemia
-- |thalassemia
Developmental |milestones |by | 9 |months |- |correct |answer |✔-- |Pulls |to |stand
-- |Cruises |(walks |holding |onto |furniture)
-- | 3 |finger |pincer |grasp
-- |says |mama-dada
Developmental |milestones |by |Age | 1 |- |correct |answer |✔-- |starts |walking |w/o |support
-- | 2 |finger |pincer
-- |stack |3 |CUBES
Developmental |milestones |by |Age | 2 |- |correct |answer |✔-- |Two |word |sentences
-- |stack |6 |cubes
-- |Parallel |play |(TWO |children |play |together)
-- |preference |of |word |"NO" |(two-letter |word)
-- |able |to |run |with |two |legs
Developmental |milestones |by |Age | 3 |- |correct |answer |✔-- |Draw |a |Circle |(Pi- 3.14)
-- |TRIcycle |riding
-- |three |word |senteneces
-- |can |dress/undress |unless |there |are |buttons
Developmental |milestones |by |Age | 4 |- |correct |answer |✔-- |Draw |cross |(4 |corners) |or |rectangle
-- |hop |on |one |foot |(4 |letters)
-- |cooperative |play |(think |cooperateive |binding |4 |O2 |for |Hgb)
-- |recognizes |color
Developmental |milestones |by |Age | 5 |- |correct |answer |✔-- |draw |a |square
-- |skip
-- |catch |a |ball
-- |print |own |name
-- |tie |shoelaces
Anticipatory |Guidance: |Sleeping |- |correct |answer |✔-- |sleep |on |back |with |no |stuffed |animals, |only |small |blankets
--- |use |of |firm |surface
-- |avoid |bed |sharing |with |infant |
-- |rear |facing |car |sear |positioned |in |the |back
-- |delayed |intro |of |solid |foods |until |4-6 |months |of |age |and |cow's |milk |until | 1 |yr |of |age
Situations |where |minors |do |NOT |require |parental |consent |- |correct |answer
|✔minor |is |EMANCIPATED |by |marriage, |self-supporting, |has |children, |or |military |and |comes |in |for
-- |Contraceptive |services
-- |pregnancy- |related |care
-- |treatment |for |STDs
Three |Cs |of |Addiction: |- |correct |answer |✔1. |Compulsion |to |use
- |Lack |of |Control
- |Continued |use |despite |adverse |consequences
The |annual |quit |rate |for |smokers |without |any |medical |interventions |is |about |-
|correct |answer |✔2% |to |3% |per |year.
Indication |for |Varenicline |use |- |correct |answer |✔Due |to |side |effects, |varenicline |is |often |reserved |for |those |that |have |failed |bupropion |or |if |a |patient |specifically |requests |it.
MOA |and |SE |of |Varenicline |(Chantix) |- |correct |answer |✔-- |Mechanism: |Nicotine |receptor |blocker.
-- |Use: |Started |a |week |before |the |quit |date, |titrated |up, |and |maintained |for |two |to |three |months. |Should |NOT |be |used |with |nicotine |replacement.
-- |Adverse |effects: |mc |side |effect |is |nausea |(30% |to |40%). |This |can |be |reduced |by |taking |it |with |food. |There |is |a |black |box |warning |on |psychiatric |disorders |and |suicide, |but |more |recent |research |has |not |confirmed |this.
Bupropion |(Wellbutrin) |MOA, |use, |SE, |Contraindications-- |HY |- |correct |answer
|✔Mechanism: |
-- |Norepinephrine |and |dopamine |reuptake |inhibitor.
Use: |It |is |started |a |week |before |the |quit |smoking |date. |The |dose |is |titrated |up |and |maintained |for |two |to |three |months. |It |*may |be |used |in |conjunction |with
|nicotine-replacement |methods* |especially |those |that |can |be |titrated |during |the |day.
Adverse |effects:
-- |associated |with |an |increase |in |suicide |in |adolescents |and |young |adults.
Contraindications: |
-- |It |should |not |be |used |in |patients |with |seizures-- |HYYY |and |with |caution |in |those |with |significant |renal |or |hepatic |impairment.
HEEADSSS |Approach |to |Adolescent |Counseling |- |correct |answer |✔
Cervical |Cancer |Screening |Guidelines |-- |VHY |- |correct |answer |✔-- |At |age |21: |cervical |cancer |screening |should |begin.
-- |Between |ages |21- |29: |q3 |years.
-- |Between |ages |30-65: |screening |can |be |done |q5 |years |if |co-tested |for |HPV |(preferred) |or |every |three |years |with |cytology |alone |(acceptable).
What |do |you |think |are |the |risk |factors |for |developing |cervical |cancer?" |Select |all |that |apply.
A. |Early |onset |of |sexual |intercourse.
B. |Multiple |sexual |partners.
C. |Cigarette |smoking.
D. |Immunosuppressed |patient. |- |correct |answer |✔All |of |the |above
- |Diethylstilbestrol |(DES) |exposure |in |utero.
Schedules |-- |HY |- |correct |answer |✔-- |If |the |first |dose |of |HPV |vaccine |is |given |before |the |15th |birthday, |vaccination |should |be |completed |according |to |a |2-dose |schedule.
-- |In |a |2-dose |series, |the |second |dose |is |recommended |*6-12 |months |after
the |first |dose* |(0, |6-12 |month |schedule)
Lung |Cancer |Screening |Recommendations |-- |VHY |- |correct |answer |✔annual |screening |with |a |low-dose |CT |scan |to |screen |for |lung |cancer |in |patients |ages |55 |to |80 |who |have |smoked |for |30-plus |years.
To |be |considered, |the |patient |should |also |be |currently |smoking |or |have |quit |within |the |prior | 15 |years.
Ovarian |Cancer |Screening |Recommendations |-- |HY |- |correct |answer |✔USPSTF, |ACOG |and |ACP |all |
recommend |AGAINST |routine |screening |for |ovarian |cancer
Recommendations |for |Breast |Cancer |Screening |Mammography |-- |HY |- |correct
|answer |✔1) |USPSTF: |DO |NOT |recommend |routine |mammography |for |women |younger |than | 50 |years |unless |they |fall |into |a |high-risk |category |such |as |women |with |a |known |BRCA |mutation.
-- |recommends |biennial |testing |for |women |between |the |ages |of | 50 |and |74
-- |insufficient |evidence |to |assess |the |benefits |versus |risk |of |screenings |in |women |after |the |age |of | 75
|2) |ACS |and |ACOG-- |yearly |mammograms |starting |at |age |40, |continuing |as |long |as |the |woman |is |in |good |health
characteristics |of |breast |on |physical |exam |that |increase |the |suspicion |of
|malignancy |- |correct |answer |✔-- |a |single, |hard, |immobile |lesion |of |approximately |>/= |2cm |with |irregular |borders
Screening |guidelines |for |clinical |breast |exams |- |correct |answer |✔USPSTF
-- |does |NOT |recommend |breast |self-exams |(BSE's).
-- |Breast |self-examination |increases |the |number |of |biopsies |performed.
-- |insufficient |evidence |to |assess |the |additional |benefits |and |harms |of |clinical |breast |exam |beyond |screening |mammography |in |women | 40 |years |or |older
|ACS |
-- |recommends |that |CBE |should |be |part |of |a |periodic |health |exam |about |every |three |years |for |women |in |their |20s |and |30s |and |every |year |for |women | 40 |and |over
Benefits |and |risks |of |mammography |- |correct |answer |✔Benefits
-- |good |screening |test |that |can |detect |asymptomatic |early |stage |disease, |and |there |is |good |evidence |that |mammography |decreases |breast |cancer |mortality.
Risks;
-- |potential |for |false |positive |results |(leading |to |unnecessary |procedures) |or |false |negative |results |(more |common |in |younger |women |since |denser |breast |tissue |makes |it |harder |to |find |abnormalities |on |x-rays)
-- |also |can |be |uncomfortable |for |patients
Question
D. |Age |(The |incidence |of |breast |cancer |is |significantly |greater |in |postmenopausal |women, |and |age |is |often |the |only |known |risk |factor.))
E. |Post-menopausal |obesity
F. |Excessive |alcohol |intake |
Other |hormonal |risk |factors |include: |
Advanced |age |at |first |pregnancy, |Exposure |to |diethylstilbestrol, |Hormone |therapy
Environmental |factors |include: |Therapeutic |radiation, |Obesity |in |postmenopausal |women, |Excessive |alcohol |intake, |Smoking
Confirmation |screen |for |menopause |- |correct |answer |✔Only |after |a |woman |has |not |menstruated |for | 12 |straight |months |
-- |Women |who |smoke |tend |to |go |through |menopause |a |few |years |earlier |than |nonsmokers.
Screening |for |Osteoporosis: |T-score |- |correct |answer |✔bone |mineral |density |at |the |site |when |compared |to |the |young |normal |reference |mean
-- |A |T-score |of |greater |than |2.5 |standard |deviations |below |the |Young |Normal |reference |mean |is |diagnostic |of |osteoporosis.
-- |A |T-score |of |between | 1 |and |2.5 |standard |deviations |below |the |normal |is |considered |diagnostic |of |osteopenia.
Screening |for |Osteoporosis: |Z-score |- |correct |answer |✔comparison |to |the |age- matched |normal |and |is |usually |used |in |cases |of |severe |osteoporosis
-- |most |useful |when |the |score |is |less |than |two |standard |deviations |below |this |normal
-- |In |this |setting, |it |is |helpful |to |scrutinize |for |coexisting |illnesses |that |may |contribute |to |osteoporosis |such |as |glucocorticoid |therapy, |hyperparathyroidism, |or |alcoholism.
Recommendations |for |Osteoporosis |Screening-- |VHY |- |correct |answer |✔USPSTF |recommend |screening |in |ALL |women |>65yo |with |DEXA |(dual |energy |x-ray |absorptiometry) |and |consider |for |younger |pts |with |other |risk |factors
Risk |factors |for |osteoporosis |- |correct |answer |✔-- |Age
-- |Glucocorticoid |intake
-- |Excessive |alcohol |intake
-- |Low |body |weight |(< | 127 |lbs)
-- |cigarette |smoking
-- |rheumatoid |arthritis
-- |previous |fracture
-- |parental |history |of |hip |fracture
Lifestyle |Changes |to |Prevent |Progression |of |Osteopenia |- |correct |answer
|✔postmenopausal |women |<70 |years |old |consume
-- |*1,200 |mg |of |calcium
|+ | 600 |units |of |vitamin |D |per |day* |to |help |prevent |bone |mineral |density |loss
70: |vitamin |D |intake |should |increase |to | 800 |units |per |day.
BMI |classifications |for |adults |- |correct |answer |✔Underweight: |<18.
Normal: |18.5-24.9 |
Overweight: |25.0-29.
Obesity |class |
- |I: |30.0-34. - |II: |35.0-39. - |III |(MORBID) |: |at |or |over | 40
Parameters |to |consider |in |Obesity |- |correct |answer |✔BMI |and |Waist |circumference
-- |In |adults |with |a |BMI |of | 25 |to |34.9 |kg/m2, |
-- |a |waist |circumference |greater |than | 102 |cm |(40 |in) |for |men
|and |88 |cm |(35 |in) |for |women |is |associated |with |a |greater |risk |of |hypertension, |Type | 2 |diabetes, |and |dyslipidemia |and |CHD.
CDC |Recommendation |on |Zoster |vaccine-- |HY |- |correct |answer |✔recombinant |zoster |vaccine |(Shingrix) |be |given |to |every |adult |at |age |50.
-- |2-vaccine |series |given |two |to |six |months |apart
-- |Adults |over | 60 |who |previously |received |the |live |zoster |vaccine |(Zostavax) |should |be |re-vaccinated |with |the |recombinant |vaccine
Most |common |cause |of |typical |CAP |- |correct |answer |✔S. |pneumoniae |> |H. |influ |> |Kleb
ECG |Changes |That |Suggest |Coronary |Artery |Disease |- |correct |answer |✔
Appropriate |steps |to |manage |high |risk |for |an |ASCVD |event |include |- |correct
|answer |✔starting |aspirin |and |begining |a |moderate-to |high-intensity |statin.
Indications |for |Exercise |Stress |Testing |- |correct |answer |✔Asymptomatic |male |patients |over | 45 |years |of |age |with |one |or |more |risk |factors(hypercholesterolemia, |hypertension, |smoking, |or |family |history |of |premature |coronary |artery |disease) |may |obtain |useful |prognostic |information |from |exercise |testing.
Next |best |step |in |Dx |of |pts |with |high |clinical |suspicion |for |pneumonia |- |correct
|answer |✔Chest |radiography |is |the |next |best |step |in |diagnosis.
-- |For |a |patient |presenting |with |egophony, |dullness |to |percussion, |fever, |productive |sputum, |and |pleuritic |chest |pain, |pneumonia |should |be |at |the |top |of |the |differential.
Most |cases |of |CAP |result |from |- |correct |answer |✔aspiration |of |oropharyngeal |secretions
Most |common |cause |of |atypical |CAP |- |correct |answer |✔Mycoplasma |pneumoniae
Empiric |tx |for |CAP |requires |coverage |for |which |orgs? |- |correct |answer |✔typical |and |atypical
Empiric |o/p |Tx |of |choice |for |CAP |in |pt |<60 |yoa? |-- |VHY |- |correct |answer
|✔Macrolides |or |doxycycline
