ABFM In training exam pearls 2022 COMPLETE SOLUTION

ABFM In training exam pearls 2022 COMPLETE SOLUTION Pre-exposure prophylaxis (PrEP), what meds, and what do you have check first? - ✔✔Emtricitabine/tenofovir gotta check Hep B first -apparently they kill hep B too, ...

ABFM In training exam pearls 2022 COMPLETE SOLUTION Pre-exposure prophylaxis (PrEP), what meds, and what do you have check first? - ✔✔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! - ✔✔120 minutes time limit from onset of MI to balloon time - ✔✔should get it done w/in 12 hours Absolute contraindications to Fibrinolysis - ✔✔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 - ✔✔Acute inflammation of the gallbladder wall Patient with pulmonary HTN due to left heart failure, can they have vasodilators (PDE5?) - ✔✔NO! can make things worse -maximize heart failure treatment! Sever's Diseaese - ✔✔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 15. 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! - ✔✔recommended that pressure ulcers not be cleaned with povidone/iodine, Dakin's solution, hydrogen peroxide, wet-to-dry dressings, or any solutions that may impede granulation tissue formation. These sites should be cleaned with either saline or tap water and covered with hydrocolloid, foam, or another nonadherent dressing that promotes a moist environment. Chronic paraoxysmal hemicrania - ✔✔resembles cluster headache but has some important differences. Like cluster headaches, these headaches are unilateral and accompanied by conjunctival hyperemia and rhinorrhea. However, these headaches are more frequent in women, and the paroxysms occur many times each day. This type of headache falls into a group of headaches that have been labeled indomethacin-responsive headaches because they respond dramatically to *indomethacin.* normal spirometry but low DLCO - ✔✔chronic pulmonary embolus Antibiotic ppx for dental procedures - ✔✔give amoxicillin only if prior endocarditis, prosthetic valve, heart txp, or severe or repaired congenital heart -if allergic to penicillin, then give clinda!! when to refer patient with CKD to nephrology - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔Confusion Assessment Method (CAM) to diagnose adult ADHD, symptoms must be present before what age? - ✔✔Age 12 Complications of GERD in infants - ✔✔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" - ✔✔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 - ✔✔need to increase by 30% because gastritis decreases absorption of thyroid. ex: h. pylori, treat h.pylori to negate this effect cubital tunnel syndrome - ✔✔irritation, compression, and entrapment of the ulnar nerve in ages 5-16, what is the most common agent that causes pneumonia - ✔✔mycoplasma - treat with azithromycin what halts the worsening of thyroid complications such as myxedema and exophthalmos - ✔✔treating with methimazole If MRSA bacteremia, when do you get repeat blood cultures? - ✔✔2-4 days community acquired pneumonia - ✔✔a type of pneumonia that results from contagious infection outside of a hospital or clinic ie hotel stay or cruise ship Polymyalgia Rheumatica (PMR) - ✔✔a geriatric inflammatory disorder of the muscles and joints characterized by pain and stiffness hallmark of this condition is the rapid and often dramatic response, typically within a few days, to lowdose corticosteroids. In fact, the lack of response to low-dose prednisone in such a case should prompt the physician to consider another diagnosis Post exposure prophylaxis for meningitis - ✔✔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 - ✔✔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 - ✔✔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? - ✔✔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? - ✔✔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 - ✔✔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? - ✔✔NO! There is no correlation! Just do the damn CT! Rotator Cuff Muscles (SITS) - ✔✔S = supraspinatus - abduction (along with deltoid) I = infraspinatus - external rotation t = teres minor - external rotation S = subscapularis - internal rotation sickle cell kids ages 2-16 should be screened for and with what? - ✔✔Individuals with sickle cell disease are at increased risk for vascular disease, especially stroke. All sickle cell patients 2-16 years of age should be screened with transcranial Doppler ultrasonography (SOR A). fetal alcohol syndrome - ✔✔a medical condition in which body deformation or facial development or mental ability of a fetus is impaired because the mother drank alcohol while pregnant associated with clinodactyly, camptodactyly (flexion deformity of the fingers), other flexion contractures, radioulnar synostosis, scoliosis, and spinal malformations. It is also associated with many neurologic, behavioral, and cardiovascular abnormalities, as well as other types of abnormalities. Dix-Hallpike maneuver - ✔✔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 - ✔✔Escitalopram (lexapro) herbal supplement with highest risk of drug interactions? - ✔✔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) - ✔✔better efficacy Peak effect of opioids - ✔✔oral 1 hr IM - 10 min Subq- 20-30 min when to start O2 on pts with COPD? - ✔✔when PaO2 < 60 antihypertensives that help with HTN associated with OSA - ✔✔diuretics - but spironolactone does the best job highest cure rate for basal cell carcinoma? - ✔