ABFM Exam Questions with 100% Correct Answers, Exams of Community Corrections

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ABFM Exam Questions with 100% Correct Answers. child with head lice rx'd with shampoo permethrin still has nits in her can she go to school? - Correct answer yes as long as continue home remedy, nit combing and repeat permethrin shampoo in 6 days is diverticular bleeding painful? - Correct answer no - abdominal pains BP recommendation for >65 - Correct answer 150/90 young boy left hip pain afebrile ESR normal WBC normal Radiograph knee and hip normal dx? rx? - Correct answer transient synovitis rx: nsaids rx for SVTs but short-term and llong term - Correct answer CCB eg verapamil, diltiazem Page 1 of 88 16 yo fatigue on OCPs low bleed on periods normal TSH normal Hct normal RBC count MCV <80 what lab test next? - Correct answer Hgb electrophoresis - check beta thalassemia Signs of ALS - mainly motor sx - Correct answer asymmetrical weakness in legs, feet, ankles slurred speech trouble swallowing SOB wt loss mcc urge incontinence in elderly - Correct answer detrusor instability what diabetes medications are good for prevention of developing DM in pre-diabetes pt - Correct answer metformin Page 2 of 88 - new sex partner - fam hx UTI in first degree female relative first line rx primary dysmenorrhea - Correct answer nsaids surveillance for barett's esophagus without dyspasia - Correct answer endoscopy q 3 years best initial rx for keloid - Correct answer intralesional corticosteroid injections. rx osteoporosis if 10yr risk of major osteoporotic fracture > ___ % - Correct answer 20% pt with osteopenia (T <2.5) risk of fracture <20% what meds do you start on - Correct answer calcium and vit d supplements test for meniscus tears - Correct answer thessaly test This patient has low energy, menstrual irregularities, and a history of stress fractures, BMI <18...is consistent with ______ dx? what test does she need? - Correct answer the female athlete triad. She is at risk for altered bone density and needs a bone mineral density test. pt with exercise induced asthma pt can prevent this by? - Correct answer albuterol 10-15min before exercise does ankylosing spondylitis improve with exercise and activity? - Correct answer yes Page 5 of 88 also note: - pain worse in evening - stiffness worse in morning pt wwith ASCVD risk >7.5% should be started on? - Correct answer moderate-or-high intensity statin note: - fibrates don't have effect on CVD and are not part of recommendation guidelines what pneumococcal vaccine should 65yo receive - Correct answer PCV13 now and PPSV23 in 1 year mcc hearing loss in newborn - Correct answer genetics A 32-year-old female at 12 weeks gestation presents with an itchy vulvar lesion, which you diagnose as external genital warts. Which one of the following would be accurate advice regarding treatment? - The recurrence rate is low with treatment - Cryotherapy is the most effective treatment - Treatment should be based on patient preference - Treatment is effective in preventing congenital transmission - Correct answer Treatment of genital warts should be based on patient preference and cost. There is no treatment that is more effective than others, and the recurrence rate for any treatment is relatively high. Page 6 of 88 pt took extra pill prescribed by psychiatrist PMH: depression normal RR, HR diaphoretic resting symmetrical tremor 4+ reflexes dx? - Correct answer derotonin syndrome pt SOB d-dimer is positive what test to order next? - Correct answer CT angiography of chest pt experience increase in floaters but not light flashes or loss of vision dark spot in the periphery of her right eye - Correct answer retinal detachment rx COPD exacerbations - Correct answer Prednisone, 40 mg daily for 5 days pt vs ptt - Correct answer Prothrombin Time (PT) Partial Thromboplastin Time (PTT) employees with >50 employees need to have what for nursing mothers? - Correct answer reasonable unpaid break time to express milk pt with episodic pains in rectum happening for years Page 7 of 88 when can you introduce peanuts to infant diest - Correct answer before 12months - early introduction reduces peanut allergy which SSRI cause QT prolongation - Correct answer citalopram recommended drug for travelers' diarrhea in Asia - Correct answer azithromycin recommended drug for traveler's diarrhea in central america and africa - Correct answer cipro where should interpreter sit? - Correct answer sit next to or slightly behind your patient rx rosacea - Correct answer metronidazole lotion/cream/gel ivermectin cream Which one of the following radiologic features is most predictive of malignancy in a solitary pulmonary nodule? Smooth borders A ground-glass appearance Central calcification of the nodule A solid density - Correct answer A ground-glass appearance others: >10mm upper lung location Page 10 of 88 irregular borders no calcifications increasing size over time what HA1c cut off is used for managing elderly pt with DM - Correct answer A1c 8 - 9 % most effective meds for fibromylagia - Correct answer TCAs young boy still bedwets PE normal next step? - Correct answer order UA - if normal, reassure parents pt with CHF currently on lisinopril, carvedilol what drug should be added on to decrease mortality and risk of hosp? Digoxin Furosemide Isosorbide dinitrate/hydralazine (BiDil) Losartan (Cozaar) Spironolactone (Aldactone) - Correct answer spirinolactone don't add ARB - because never use ACEi with ARB exclusively BF babies need iron supplements from __ months? - Correct answer 4 months Page 11 of 88 which of the following meds cause vit b12 def? Aspirin Enalapril Metformin Simvastatin Hydrochlorothiazide - Correct answer metformin others: - h1 blocker - PPi should you screen for cervical cancer in pt with hysterectomy? - Correct answer no age of CRC screen - Correct answer 50 - 75 pt with acute lumbar pain with radiculopathy no signs of cauda equina syndrome, cancer, infection or fracture is imaging needed? - Correct answer no rx: 6 weeks pain meds, PT all infants with down syndrome should be screened for? - Correct answer cardiac problems - echocardiogram Page 12 of 88 pps for RSV *2 - 12* yo boy insidious onset of pain and mild limitation ROM of one hip joint - Correct answer Idiopathic osteonecrosis of the hip (Legg-Calvé-Perthes disease) *adolescent boy* insidious onset of pain and mild limitation ROM of one hip joint - Correct answer Slipped capital femoral epiphysis first line for n/v in pregnancy - Correct answer vitamin b6 +/- doxylamine pt with obesity DM peripheral neuropathy seizure d/o newly dx with depression what rx? - bupropion - citalopram - duloxetine - nortriptyline - Correct answer duloxetine pt with HTN Page 15 of 88 wants nonpharmacologic intervention to manage BP - Correct answer monitor home BP readings limit sodium 2400mg/day diet veggies, fruits limit alcohol 2drinks/day for men and 1drink/day for women screening rule for AAA - Correct answer one time abdominal duplex ultrasound male 65 - 75 yr ever smoked 100 cigarettes in lifetime COPT pt complain of breathlessness uses inhalers - albuterol prn and LABA daily and Anticholinergic daily what can improve his breathing problem? - Replace his inhaled medications with nebulized alternatives - Replace his tiotropium with ipratropium (Atrovent) - Order home oxygen Page 16 of 88 - Refer for outpatient pulmonary rehabilitation - Correct answer Pulmonary rehabilitation - use for COPD pt who are optimally medically managed - imrpoved exercise capacity, dyspena and health-related QOL note oxygen only improve mortality but not sx pcos pt amenorrhea obese high testosterone started on lifestyle modifications (wt loss, exercise) what meds can be added as part of initial management? - Correct answer metformin - helps with abnormal menstruation diffuse ST elevations on EKG acute sharp chest pain relieved by leaning fwd rx? - Correct answer pericarditis rx: colchicine +/- NSAIDs Severe pain and skin changes outside the realm of cellulitis, including bullae and deeper discoloration, are strong indications of necrotizing fasciitis. +fever + high HR + extreme pain movement of joint Page 17 of 88 first line rx HTN - Correct answer acei arb ccb thiazide severe Dm foot ulcer. rx with: A) Amoxicillin/clavulanate (Augmentin) B) Linezolid (Zyvox) C) Ciprofloxacin (Cipro) D) Ceftriaxone (Rocephin) and levofloxacin (Levaquin) E) Piperacillin/tazobactam (Zosyn) and vancomycin (Vancocin) - Correct answer Piperacillin/tazobactam and vancomycin - covers MRSA, pseudomonas, strep - covers gram +ve, gram -ve and anerobes 2-18 yo BMI categories <5th percentile 5 - 85th percentile 85 - 94th percentile >95 percentile - Correct answer 2-18 yo BMI <5th percentile - underwt 5 - 85th percentile - nml 85 - 94th percentile - overwt >95 percentile - obese Page 20 of 88 < 2yo BMI categories > 95th percentile - Correct answer < 2yo BMI categories > 95th percentile overwt there is no obese category Which one of the following is true regarding respiratory syncytial virus (RSV) infection? A) Most infections in the United States occur between August and December B) Corticosteroids should be a routine part of treatment C) The diagnosis is usually based on positive serology D) It is rarely associated with bacterial co-infection - Correct answer It is rarely associated with bacterial co-infection Infection: Nov-April Don't use steroids for rx first line rx CAP in infant/school-aged child - Correct answer amoxicillin adolescent - azithromycin to cover m. pneumonaie Page 21 of 88 non-obese 2-8 yo child with OSA rx? - Correct answer adenotonsillectomy - peak tonsil growth at this age pt with CKD - low ferritin - low hgb - low hct - MCV <80 rx? - Correct answer iron supplement - Ferrous sulfate orally adolescent child (teens) pain in groin or anterior thigh or referred pain to knee + limping dx? - Correct answer slipped capital femoral epiphysis pt with PSD should be started on ____ or ptesent CVD eg MI, stroke - Correct answer aspirin clopidogrel older adult + FABER Page 22 of 88 pt report diffuse pain all over body pain occurs when someone touches pt whct is dx? - Correct answer Opioid-induced hyperalgesia management - reducing the current opioid dosage - eliminating the current opioid and starting another opioid. pt unable to conceive regular periods denies heat/cold tolerance sperm test normal what test to order next? A) Observation for 1 year B) TSH, free T4, and prolactin levels C) Hysterosalpingography D) An estradiol level E) A luteal-phase progesterone level - Correct answer A luteal-phase progesterone level - check progesterone level after ovulation - should be >5 after Day21 of cycle to indicate ovulation - if <5, then no ovulation - need to check TSH, T4 and prolactin for anovulation - if >5, then need to do hysterosalpingography for any obstruction Page 25 of 88 rx acute flare up/exacerbations of MS - Correct answer steroids rx for serotonin syndrome - Correct answer benzos - lorazepam, diazepam if non-responsive to benzos - cyproheptadine dx of sepsis severe sepsis septic shock - Correct answer dx of sepsis - high WBCs severe sepsis - high WBCs and organ dysfunction (Cr >0.5, thrombocytopenia, hyperbilirubinemia) septic shock - hyperlactatemia, hypotension refractory to IV fluids list things that minimize pain of lidocaine injection - Correct answer - buffer the solution with sodium bicarbonate - warm solution to room temp - inject into subQ tissue - rapid insertion of needle in skin - inject slowly and steadily while withdrawing the needle children with what diseases are indicated for second dose of pneumococcal polysaccharide vaccine? - Correct answer - sickle cell disease Page 26 of 88 - anatomic of functional asplenia - HIV+ - immunocompromised with renal failure or leukemia leading cause of death in RA pts A) Infections B) Coronary artery disease C) Thromboembolic disease D) Lymphoma E) Lung cancer - Correct answer CAD what do you advice parents of a 5yo with uncomplicated femoral anteversion (in-toeing) - Correct answer observation Effective treatments for obsessive-compulsive disorder include A) Freudian analysis B) benzodiazepines C) amphetamine salts D) atypical antipsychotics E) repetitive exposure to fearful stimuli - Correct answer repetitive exposure to fearful stimuli rx postherpatic neuralgia - Correct answer lidocaine patches Page 27 of 88 A) HIV infection B) histoplasmosis C) coccidioidomycosis D) tuberculosis E) cryptococcosis - Correct answer histoplasmosis - birds,bats pt with hx easy bruising currently asymptomatic Platelets - less than normal A workup is negative for - autoimmune causes, including Graves disease, HIV, Epstein-Barr virus, cytomegalovirus, varicella zoster, hepatitis C, and Helicobacter pylori dx? rx? - Correct answer idipathic (immune) thrombocytopenic purpura rx: steroids Terminally ill cancer patients who receive palliative chemotherapy are are _____ likely to die at home are _____ likely to undergo CPR are _____ likely to undergo mechanical ventilation are referred to hospice ______ (earlier or later) in their disease course - Correct answer Terminally ill cancer patients who receive palliative chemotherapy are are less likely to die at home Page 30 of 88 are more likely to undergo CPR are more likely to undergo mechanical ventilation are referred to hospice later in their disease course rx COPD exacerbation - Correct answer Oral prednisone for 5 days tamoxifen vs raloxifene - breast - bone - endometrium - Correct answer tamoxifen - breast: estrogen antagonist - bone: estrogen agonist - endometrium: estrogen agonist raloxifene - breast: estrogen antagonist - bone: estrogen agonist - endometrium: estrogen antagonist CI for OCPs - Correct answer Age ≥35 years and smoking ≥15 cigarettes per day ●Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension) Page 31 of 88 ●Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) ●Venous thromboembolism ●Known thrombogenic mutations ●Known ischemic heart disease ●History of stroke ●Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis) ●Systemic lupus erythematosus (positive or unknown antiphospholipid antibodies) ●Migraine with aura at any age ●Breast cancer ●Cirrhosis ●Hepatocellular adenoma or malignant hepatoma CI for Levo (progestin only) - IUD - Correct answer hx breast cancer hx liver cancer suspected pregnancy acute pelvic infection Page 32 of 88 D) Meloxicam (Mobic) E) Naproxen (Naprosyn) - Correct answer naproxen pt with 4 day history of hoarseness cough +sputum tender sinuses nasal congestion afebrile normal ear and lung exams dx? rx? - Correct answer acute laryngitis symptom relief - most likley viral FEV/FVC ratio in obstructive vs restrictive lung disease - Correct answer obstructive <0.7 restrictive >0.7 pt with DOE, crackles in lung fields, dry cough, FEV/FVC ratio >0.7 - signs of restrictive lung disease what drug is cause? A) Lisinopril (Prinivil, Zestril) B) Conjugated estrogens (Premarin) Page 35 of 88 C) Omeprazole (Prilosec) D) Solifenacin (Vesicare) E) Nitrofurantoin (Macrodantin) - Correct answer nitrofurantoin other drugs that cause ILD: - amiodarone all preg women should be screen for ___ at 11 to 16 weeks - Correct answer asymptomatic bacteriuria - UA and culture signs of autism - Correct answer delayed social development language delay abnormal sensitivity to normal noises athlete with low risk stress fracture of tibia counselled on no wt bearing for 5 weeks after 5 weeks, pt can walk with no pain. when can pt return to physical activity? - Correct answer after normal physical exam of the tibia most stress fractures heel in 6 - 10 weeks Page 36 of 88 no need for XRay to confirm heel as long as pt has no pain walking, can return to actvitieis <40 yo male blood in semen normal testes and prostate exam pt is sexually active what next? - Correct answer get STD screen - it is normal to see blood in semen in <40yo men rx recommendation for IBS A) Amitriptyline B) Clarithromycin (Biaxin) C) Loperamide (Imodium) D) Increased intake of insoluble dietary fiber - Correct answer TCA SSRI safest influenza vaccine for patient allergic to eggs A) Live attenuated trivalent influenza vaccine B) Recombinant trivalent influenza vaccine C) Inactivated trivalent influenza vaccine Page 37 of 88 cut off for ankle=brachial index - Correct answer <0.90 more severe PAD 0.91 - 0.99 borderline PAD 1 - 1.40 normal >1.5 imcompressible vessels assoc with DM, elderly ppx drug for lyme disease A) Amoxicillin B) Ceftriaxone (Rocephin) C) Cefuroxime axetil (Ceftin) D) Doxycycline E) Clarithromycin (Biaxin) - Correct answer doxycycline rx superficial burn (painful patches of erythema and dry skin, no blisters) A) Cleaning the wound with povidone iodine (Betadine) B) Covering the wound with an occlusive dressing C) Applying aloe D) Applying hydrocortisone 1% cream E) Starting broad-spectrum antibiotics - Correct answer apply aloe, honey, lotion initial screening for hemochromatosis A) Serum transaminases Page 40 of 88 B) A CBC and a serum iron level C) Testing for the HFE gene D) Ferritin and transferrin saturation E) Total iron binding capacity - Correct answer Ferritin and transferrin saturation - will be elevated then check HFE complication of hypoparathyroidism A) somnolence B) low vitamin D C) muscle flaccidity D) hyperkalemia E) refractory heart failure - Correct answer hypocalcemia - refractory heart failure - muscle twitch - muscle spasm/ tetany - seizures - altered mental status - stridor rx options for narrow complex SVTs - Correct answer adenosine vagal maneuvers which psychosis drug are assoc with high risk of death due to stroke and cardiac arrest in elderly - Correct answer 2nd generation anti-psychotics Page 41 of 88 eg quietapine The most common source of chest pain in children is A) pulmonary B) cardiac C) musculoskeletal D) gastroesophageal E) psychogenic - Correct answer msk <10mm hyperplastic polyp in colon when to repeat next screen - Correct answer 10 yrs who should be screened for Hep B infection - Correct answer Patients on chronic immunosuppressive therapy Patients with end-stage renal disease who are on hemodialysis Household contacts of individuals with chronic hepatitis B Pregnant women with no risk factors for hepatitis B IVDU hx ppl who have infected sexual partners infants of infected mothers Page 42 of 88 does she need back up contraception? - Correct answer NO only if inserted after 7 days of menstrual bleed - use backup contraception for the next 7 days rx SEVERE c diff infection vs MILD - Correct answer severe - oral vanc mild/mod - oral metro pt with celic disease has increase risk of A) Diverticulitis B) Ulcerative colitis C) Crohn's disease D) Colon cancer E) Osteoporosis - Correct answer osteoporosis - decrease vit c and d absorption Which one of the following would be appropriate to detect endometriosis? A) A CA-125 assay B) Transvaginal ultrasonography C) CT of the pelvis D) MRI of the pelvis E) Colonoscopy - Correct answer transvaginal ultrasonography severity of anorexia nervosa is based on which one of the following? Page 45 of 88 A) Refusal to eat B) The frequency of episodes of binge eating or purging behavior C) Body mass index (BMI) D) The presence or absence of amenorrhea E) Orthostatic changes in pulse or blood pressure - Correct answer BMI >17 mild 16 - 16.9 moderate 15 - 15.9 severe <15 extreme conditions that increase risk latent TB progress to active disease - Correct answer lung cancer DM alcoholism immunosuppression silicosis when is the only time to give pps antibiotics to prevent bacterial endocarditis with dental/GI procedures - Correct answer prosthetic valve hx endocarditis heart transplant pt that develop valvular disease Page 46 of 88 NOTE - NOT mvp or mr one benefit of treatment of GDM is a decreased risk for A) maternal type 2 diabetes mellitus after delivery B) maternal preeclampsia C) perinatal death D) a small-for-gestational-age infant - Correct answer maternal precelampsia others: - decrease risk for operative delivery, large-for-GA infant, shoulder dystocia A 45-year-old male is seen for a well-demarcated, nonpruritic rash in the right axilla. It is fine-scaled with a cigarette-paper appearance. The rash has a coral-red fluorescence under a Wood's light. Which one of the following is the most likely diagnosis? A) Candidiasis B) Tinea cruris C) Erythrasma D) Inverse psoriasis - Correct answer C) Erythrasma pt delivers placenta and begins to bleed....lead to soft boggy uterus, what is this? - Correct answer uterine atony and postpartum hemorrhage these drugs rx uterine atony and postpartum hemorrhage Page 47 of 88 rx otitis media A) Amoxicillin, 40-50 mg/kg, for 10 days B) Amoxicillin, 80-90 mg/kg, for 10 days C) Amoxicillin/clavulanate (Augmentin), 90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate, divided into two doses, for 7 days D) Cefdinir, 14 mg/kg/day for 10 days E) Ciprofloxacin (Cipro), 10-20 mg/kg for 7 days - Correct answer Amoxicillin, 80-90 mg/kg, for 10 days UNLESS - child has recent rx amox in last 30days - concurrent purulent conjunctivitis - hx AOM unresponsive to amox then rx with amox/clav rx exercise induced asthma - Correct answer inhaled daily steroids + albuterol prn 15 yo male with night time cough and wheezing. you suspect asthma. next step? A) Treat empirically with a short-acting $-agonist B) Perform spirometry C) Order radiologic testing D) Start an inhaled corticosteroid E) Start a leukotriene inhibitor - Correct answer spirometry Page 50 of 88 pt with lower abdominal/pelvic pain. On examination, with the patient in a supine position, you palpate the tender area of her lower abdomen. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies. dx? A) Appendicitis B) A hematoma within the abdominal wall musculature C) Diverticulitis D) Pelvic inflammatory disease E) An ovarian cyst - Correct answer hematoma in abdominal wall Mild cognitive impairment is characterized by which one of the following? A) Localized motor dysfunction B) Impairment in at least one activity of daily living C) Impairment in at least one instrumental activity of daily living D) The presence of the APO E4 allele E) Objective evidence of memory decline - Correct answer in between normal cognition and dementia Objective evidence of memory decline Page 51 of 88 + normal functional abilities pt with tetanus-suspected wound has hx primary vaccines recent Tdap booster <5 yrs ago what next A) TT (tetanus toxoid) B) Td (tetanus toxoid with reduced diphtheria) C) Tdap (tetanus toxoid with reduced diphtheria and acellular pertussis) D) TIG (tetanus immune globulin) E) No immunization - Correct answer nothing pt with tetanus-suspected wound has hx primary vaccines recent Tdap booster >5 yrs ago what next A) TT (tetanus toxoid) Page 52 of 88 clarithromycin inhibits cyp450 high amlodipine lead to hypotension, edema, AKI DM pt with high glucose levels at night currently on lantus at night what next A) Adding rapid-acting insulin at breakfast B) Adding rapid-acting insulin at lunch C) Adding rapid-acting insulin at dinner D) Increasing the nightly insulin glargine dose E) Increasing the insulin glargine dosage and giving two-thirds in the morning and one-third at night - Correct answer Adding rapid-acting insulin at dinner DM pt with high glucose levels before dinner currently on lantus at night what next Page 55 of 88 A) Adding rapid-acting insulin at breakfast B) Adding rapid-acting insulin at lunch C) Adding rapid-acting insulin at dinner D) Increasing the nightly insulin glargine dose E) Increasing the insulin glargine dosage and giving two-thirds in the morning and one-third at night - Correct answer Adding rapid-acting insulin at lunch pt with bradycardia on EKG + feeling tired for past few months next steps A) Clearance for eye surgery with no further evaluation B) An exercise treadmill test C) A 48-hour Holter monitor D) A 7-day event monitor E) Referral to a cardiologist for pacemaker placement - Correct answer referral found <10mm hyperplastic polyp next colonoscopy in ___ years - Correct answer 10 years pt with hypothyroidism wants a more "natural" rx regimen while pregnant Page 56 of 88 recommend? A) Continue the current dosage of levothyroxine B) Reduce the current dosage of levothyroxine to 50 ug daily C) Change to a comparable dosage of combination levothyroxine/L- triiodothyronine D) Change to a comparable dosage of desiccated thyroid - Correct answer continue current levo A 35-year-old female with a history of chronic abdominal pain and diarrhea develops tender red nodules on her shins. These findings are most consistent with which one of the following? A) Celiac disease B) Crohn's disease C) Diverticular disease D) Irritable bowel syndrome E) Clostridium difficile colitis - Correct answer crohns - erythema nodosum (shins) - anemia - inflammatory athropathies - uveitis - venous thromboembolism postmenopasusal estrogen + progesterone assoc with DECREASE in Page 57 of 88 D) Start magnesium sulfate, lower blood pressure to 140/90 mm Hg, and induce labor at 37 weeks gestation E) Arrange for urgent cesarean section - Correct answer Start magnesium sulfate and induce labor now steroids not recommended after 34weeks pt had otitis media 3weeks ago and was started on amox 90mg/kg/day for 10d now another AOM presents rx? A) Amoxicillin, 45 mg/kg/day for 10 days B) Amoxicillin, 90 mg/kg/day for 10 days C) Amoxicillin, 90 mg/kg/day for 10 days followed by prophylactic treatment with amoxicillin for 6 months D) Amoxicillin/clavulanate (Augmentin), 90 mg/kg/day for 10 days E) Amoxicillin/clavulanate, 90 mg/kg/day for 10 days followed by prophylactic treatment with amoxicillin for 6 months - Correct answer Amoxicillin/clavulanate (Augmentin), 90 mg/kg/day for 10 days typmanostomy Page 60 of 88 - for 3 AOM in 6 months Which one of the following is the best exercise to improve function in older adults living in nursing homes? function = muscle strength, chair-to-stand time, stair climbing, gait speed, balance A) Swimming B) Walking C) Stretching D) Stationary bicycling E) Resistance training - Correct answer Resistance training A 55-year-old male has a 3-month history of chronic shortness of breath and dyspnea on exertion. His physical examination is unremarkable except for 1+ ankle edema bilaterally and a soft systolic murmur. A stress echocardiogram is normal. Pulmonary function tests are normal except for a low diffusing capacity of the lung for carbon monoxide (DLCO). Which one of the following conditions should be considered in this patient? A) Chronic pulmonary thromboembolism B) Emphysema C) Interstitial lung disease D) Asthma Page 61 of 88 E) Hypersensitivity pneumonitis - Correct answer PE - normal PFTs and low DLCO interstitial lung disease - restrictive PFT and low DLCO what do muscle strenght grades mean 0 1 2 3 4 5 - Correct answer 0 unable to contract muscle 1 contract muscle but no movement 2 move but not against gravity 3 move against gravity 4 move against gravity + additional resistance 5 move against gravity + substantial resistance ppx cluster HA - Correct answer verapamil Page 62 of 88 + palpable nontender gall bladder dx? - Correct answer pancreatic cancer Hyperbaric oxygen treatment has been shown to be beneficial for which one of the following conditions? A) Tinnitus B) Malignant otitis externa C) Crush injury wounds D) Nonunion of bone fractures E) Vascular dementia - Correct answer crush injury decompression sickness pt with pharyngitis rx with amoxicillin for 10days on day 8, present with generalized rash A) Continue the amoxicillin and begin prednisone and diphenhydramine (Benadryl) B) Continue the amoxicillin and change the diagnosis to scarlet fever C) Discontinue the amoxicillin and change the diagnosis to viral exanthem Page 65 of 88 D) Discontinue the amoxicillin and note amoxicillin as a potential allergy in her record - Correct answer Discontinue the amoxicillin and note amoxicillin as a potential allergy in her record An obese 70-year-old male with chronic pain due to osteoarthritis complains of fatigue, anhedonia, hypersomnolence, and increased appetite. Which one of the following would be the best pharmacologic agent for this patient?' A) Duloxetine (Cymbalta) B) Mirtazapine (Remeron) C) Citalopram (Celexa) D) Paroxetine (Paxil) E) Nortriptyline (Pamelor) - Correct answer Duloxetine - chronic pain and depression pt with rash that resemble pitryriasis rosacea. you're not sure what to order next A) a fungal culture B) heterophile antibody testing C) a platelet count D) a rapid plasma reagin (RPR) test E) a TSH level - Correct answer check syphillis When should preg women get Tdap A) Post partum B) At this visit Page 66 of 88 C) Anytime after the first trimester D) Between 27 and 36 weeks gestation E) 10 years after the last dose - Correct answer 27 - 36 weeks A 77-year-old female is admitted to the critical care unit for acute respiratory failure and is on a ventilator for more than 48 hours. Stress ulcer prophylaxis is ordered. This prophylaxis should be continued until A) venous thromboembolism prophylaxis is stopped B) the patient is transferred out of the critical care unit C) the patient is discharged from the hospital D) the patient is discharged from a skilled care or rehabilitation care facility E) 30 days after discharge from the hospital - Correct answer the patient is transferred out of the critical care unit rx uveitis with ankylosing spondylitis A) Artificial tears B) Ocular antibiotics C) Ocular corticosteroids D) Oral acetazolamide E) Ophthalmic olopatadine (Patanol) - Correct answer ocular steroids intermittent unilateral rhinorrhea Page 67 of 88 B) Lisinopril (Prinivil, Zestril) C) Amlodipine (Norvasc) D) Simvastatin (Zocor) E) Omeprazole (Prilosec) - Correct answer omeprazole and ranitidine 1st line rx for menstrual irregularity, hirsutism and acne in PCOS? - Correct answer OCPs pt on vancomycin, b-blocker, escitalorpam ad TMP/SMX(bactrim) has anaphylactic drug rxn given epinephrine but no improvement after 15min what next? A) Another dose of intramuscular epinephrine B) Another dose of intravenous methylprednisolone C) Another dose of intravenous diphenhydramine D) Intramuscular glucagon E) Intramuscular betamethasone sodium phosphate/betamethasone acetate (Celestone Soluspan) - Correct answer give IM glucagon - antidote for b-blocker Page 70 of 88 b blocker may prevent epinephrine from working if the pt wasn't taking b-blocker, give another dose of epinephrine greatest risk factor for GBS infection in preg woman A) Fetal tachycardia B) Delivery at less than 35 weeks gestation C) Rupture of the membranes 12 hours before delivery D) Gestational diabetes during the pregnancy E) Use of vacuum extraction during delivery - Correct answer preterm delivery pt with advanced dementia, lost all ADL. Has trouble with oral intake not not getting enough nutrients what is best approach A) Clear liquids B) Intravenous fluids C) Hand feeding D) Percutaneous endoscopic gastrostomy (PEG) tube feeding E) Nasogastric tube feeding - Correct answer hand feeding >>>>> PEG PEG - assoc with restraints, agitation and pressure ulcers home oxygen for hypoxemia is given to COPD pts after hospitalization for pneumonia Page 71 of 88 what is next step for home oxygen use? A) Reduce oxygen use to nighttime only B) Stop oxygen when his course of antibiotics and corticosteroids is completed C) Reassess the need for oxygen within 3 months D) Stop oxygen within 6 months E) Continue oxygen indefinitely - Correct answer reassess need in 3 months pt with proximal muscle weakness high serum creatinine kinase and aldolase symptoms improve with steroids dx? A) Duchenne's muscular dystrophy B) Myasthenia gravis C) Amyotrophic lateral sclerosis D) Aseptic necrosis of the femoral head E) Polymyositis - Correct answer inflammatory myopathy eg dermatomyositis or polymyositis drugs used to increase uterine tone in postpartum hemorrhage A) Oxytocin (Pitocin) B) Methylergonovine Page 72 of 88 check TSH level - low what next? - Correct answer think: hyperfunctioning thyroid do radionuclide uptake scan A 60-year-old male is scheduled for coronary revascularization. Which one of the following would reduce his cardiovascular risk the most when given perioperatively? A) b-Blockers B) Calcium channel blockers C) Statins D) Aspirin E) Warfarin (Coumadin) - Correct answer statin - start 4 months before rx for pain in pt with CKD A) Acetaminophen B) Celecoxib (Celebrex) C) Oxycodone (OxyContin) D) Sulindac (Clinoril) E) Tramadol (Ultram) - Correct answer tylenol avoid nsaids - nephrotoxic Page 75 of 88 pt with secondary amennorhea (lack of menses for 3 months or irregular menses for 6 months) normal PE, negative pregnancy test, no hx of chronic disease what is next step A) A CBC and metabolic panel B) Serum LH and FSH levels C) Karyotype analysis D) Pelvic ultrasonography - Correct answer LH, FSH and TSH levels A 2-year-old female is brought in by her father for evaluation of a cough. Her cough started 10 days ago along with a runny nose and a low-grade fever. The runny nose and fever are no longer present but a dry-sounding cough persists. On examination the patient appears well and has a normal heart rate and respiratory rate. You note no retractions and lung sounds are also normal. Which one of the following would be an appropriate management option? A) Buckwheat honey B) Albuterol (Proventil, Ventolin) C) Azithromycin (Zithromax) D) Dextromethorphan E) Diphenhydramine (Benadryl) - Correct answer buckwheat honey - symptom management for viral upper resp infection pt test positive for gonorrhea and negative for chlamydia Page 76 of 88 rx? A) Doxycycline B) Azithromycin (Zithromax) C) Ceftriaxone (Rocephin) plus azithromycin D) Ofloxacin E) Cefdinir plus levofloxacin (Levaquin) - Correct answer ceftriaxone - 250mg IM azithromycin - 1g oral or doxycycline - 100mg bid x7days rx all sexual partners as well rx for CAP in - children 60 days to 5 yrs - 5 yrs to 16 yrs - Correct answer 60 days to 5 yrs Page 77 of 88 B) Weight gain C) A low risk of medication abuse D) Serious adverse cardiovascular events E) Increases in blood pressure - Correct answer increase high BP aggravate psychosis, tics In the first 24 hours after his stroke, starting treatment to control his blood pressure is recommended if it reaches what threshold level? A) 150/90 mm Hg B) 160/100 mm Hg C) 180/100 mm Hg D) 200/110 mm Hg E) 220/120 mm Hg - Correct answer 220/120 high BP actually protective in stroke but should drop down within 24hrs Which one of the following BP medications has been shown to reduce bone loss and may reduce her risk of future hip fractures? A) Amlodipine (Norvasc) B) Hydrochlorothiazide C) Lisinopril (Prinivil, Zestril) D) Losartan (Cozaar) E) Metoprolol (Lopressor, Toprol-XL) - Correct answer HCTZ - loss of benefit within 4 months of discontnuation Plan-Do-Check-Act (PDCA) describes which one of the following? Page 80 of 88 A) The accreditation process to become a patient-centered medical home B) One of the National Quality Forum's Safe Practices for Better Healthcare C) The cycle of continuous quality improvement D) Donabedian categories of quality measurement E) The Chronic Care Model - Correct answer The cycle of continuous quality improvement suspect acute pancreatitis imaging? A) no routine imaging unless the clinical course becomes complicated B) transabdominal ultrasonography C) contrast-enhanced CT D) magnetic resonance cholangiopancreatography (MRCP) E) MRI - Correct answer transabdominal ultrasonography pt on PPI for peptic ulcer disease Which one of the following would be the most appropriate calcium supplement for this patient? A) Oyster shell calcium B) Calcium carbonate C) Calcium lactate D) Calcium gluconate E) Calcium citrate - Correct answer calcium citrate - does not require acidic condition fro absorption Page 81 of 88 if not on ppi, use calcium carbonate (require acid for absorption) CI for bupropion - Correct answer seizure eating disorder MAO inhibitor pt on naltrexone for alcohol dependence ned meds for pain relief A) Fentanyl B) Hydromorphone (Dilaudid) C) Ketorolac D) Meperidine (Demerol) E) Morphine - Correct answer ketorolac - does not work on opioid receptor since naltrexone blocks these Which one of the following is most effective for assessing right ventricular dysfunction in this situation? A) Echocardiography B) Physical examination C) 12-Lead electrocardiography D) Contrast-enhanced CT of the chest - Correct answer echocardiography A 21-year-old male college student presents to the emergency department with a 2-day history of fever, severe muscle and joint pain, nausea, and vomiting. He spent his winter break traveling in South America and returned 4 days ago. On examination he has a temperature of 39.4°C Page 82 of 88 A) Vaginal estradiol B) Oral estradiol combined with progestin C) Oral phytoestrogens such as soy protein D) Oral venlafaxine (Effexor XR) E) Topical bio-identical hormones - Correct answer SSRI or SNRI pt with severe c diff rx with oral vanc no improvement Which one of the following intravenous antibiotics would be most appropriate? A) Ciprofloxacin (Cipro) B) Imipenem/cilastatin (Primaxin) C) Meropenem (Merrem) D) Metronidazole E) Vancomycin - Correct answer IV metronidazole Which one of the following is NOT a risk factor for stillbirth? A) Smoking B) Advanced maternal age C) Congenital anomalies D) Vigorous exercise E) BMI >30 kg/m2 - Correct answer vigorous exercise Which one of the following is the first-line treatment for her urge incontinence? Page 85 of 88 A) Anticholinergic drugs such as oxybutynin or solifenacin (Vesicare) B) $-Adrenergic agonists such as mirabegron (Myrbetriq) C) Duloxetine (Cymbalta) D) Bladder training E) A pessary - Correct answer bladder training Which one of the following physical examination findings would be pathognomonic for slipped capital femoral epiphysis? A) Excessive forward passive motion of the tibia with the knee flexed B) Lateral displacement of the patella with active knee flexion C) Limited internal rotation of the flexed hip D) Reduced hip abduction with the hip flexed E) An inability to extend the hip past the neutral position - Correct answer Limited internal rotation of the flexed hip A 54-year-old male presents with hearing loss associated with tinnitus. Which one of the following additional characteristics would be an indication for MRI of the brain to assess for an intracranial tumor? A) A rapid onset of symptoms B) Unilateral symptoms C) Association with pain and otorrhea in the affected ear D) Exposure to loud noise shortly before the symptoms began - Correct answer unilateral Page 86 of 88 - acoustic neuroma (hearing loss and tinnitus, slow growing tumor, vertigo) rx PAD A) Aspirin B) Warfarin (Coumadin) C) Clopidogrel (Plavix) D) Pentoxifylline E) Cilostazol (Pletal) - Correct answer cilostazol what is CI in pt taking statin A) Amoxicillin/clavulanate (Augmentin) B) Azithromycin (Zithromax) C) Clarithromycin (Biaxin) D) Doxycycline E) Levofloxacin (Levaquin) - Correct answer macrolides - inhibit cyp450 - statin metabolized by cyp450 - risk statin toxicity pt with egg allergy A) Avoid giving influenza vaccine B) Administer the live-attenuated influenza vaccine and observe for 30 minutes Page 87 of 88