AAFP Questions with accurate answers, 2022 update. Graded A+

AAFP Questions with accurate answers, 2022 update. Graded A+ A nontoxic afebrile 4 week old child appears with diffuse crackles and conjunctivitis and a prominent cough. On WBC there is prominent eosinophilia. Mos ...

AAFP Questions with accurate answers, 2022 update. Graded A+ A nontoxic afebrile 4 week old child appears with diffuse crackles and conjunctivitis and a prominent cough. On WBC there is prominent eosinophilia. Most likely etiological agent? - ✔✔Chlamydia pneumoniae (atypical pneumonia) When do we use finesteride? - ✔✔Only if PSA is above 1.5ng/mL and when there is evidence of BPH Recommended treatment for a mallet fracture? - ✔✔splinting in extension Appropriate drugs to manage bipolarism - ✔✔Lithium, valproate, lamotrigine, and some antipsychotics (including quetiapine) A young 2 year old presents with her arm pronated and flexed close to her body. She is resilient to examination of the area. What occurred and how do you fix it? - ✔✔Nursemaids elbow due to excessive traction and the annular ligament slipping superiorly between the humerus and radius Treatment for primary dysmenorrhea? - ✔✔NSAIDs Two most appropriate first steps to assess a thyroid nodule? - ✔✔ultrasound TSH level Which anti-epileptic should be titrated up slowly to avoid S-J syndrome? - ✔✔Lamotrogine Three best sources of information for providing treatment - ✔✔systematic reviews, meta-analyses, randomized controlled trials (RCTs) Flesh colored papules with an erythematous base that are located on the face and trunk of a 2 day old infant. Dx? - ✔✔erythema toxicum neonatorum A 70-year-old male with widespread metastatic prostate cancer is being cared for through a local hospice. Surgery, radiation, and hormonal therapy have failed to stop the cancer, and the goal of his care is now symptom relief. Over the past few days he has been experiencing respiratory distress. His oxygen saturation is 94% on room air and his lungs are clear to auscultation. His respiratory rate is 16/min. Best treatment? - ✔✔Morphine Two causes of bloody diarrhea that are painless? - ✔✔Diverticular bleeding and angiodysplasia A patient with persistent severe asthma may present with bruising, why? - ✔✔Inhaled corticosteroids may increase the risk of bruising in some patients benign nocturnal limb pains of childhood are what? - ✔✔growing pains- cramping feelings in calves, arms and shins Which of the following is not a first line anti-HTN therapy? ACE inhibitors B. Angiotensin receptor blockers C. Calcium channedl blockers D. β-Blockers E. Thiazide-type diuretics - ✔✔Beta blockers Why do we routinely check Na+ levels on patients taking SSRIs? - ✔✔worry about hyponatremia secondary to SIADH Four common causes of obstructive lung disease? - ✔✔COPD bronchiectasis asthma CF A patient presenting with a pericardial rub and pain only relieved by leaning forward should be given what immediately? - ✔✔NSAIDs (colchicine too)--> first line for pericarditis What viral respiratory infection is rarely associated with bacterial co-infection - ✔✔RSV In a 3 year old with assumed community acquired pneumonia what is the drug of choice to treat? - ✔✔amoxicillin (older kids get macrolides) nondisplaced midshaft clavicular fracture should be splinted how? - ✔✔sling or figure-of-eight dressing, OSA in children 2 to 8 is due primarily to what? - ✔✔enlarged adenoids and tonsils Anemia of CKD is normally treated first line how? - ✔✔oral ferous sulfate dyspnea, a nondilated left ventricle with a preserved ejection fraction all indicate what type of heart failure? - ✔✔diastolic Slipped capital femoral epiphysis (SCFE) occurs most commonly during when? - ✔✔adolescent growth spurt with knee pain Patients with symptomatic peripheral arterial disease should be started on a daily dose of either _________ or ________ - ✔✔aspirin or clopidogrel This causes dull or sharp groin pain, which in some patients radiates to the lateral hip, anterior thigh, or buttock with a positive FABER or FABIR test - ✔✔hip labral tear If a patient has bacterial diarrhea that is causing non-bloody stool and no severe symptoms how do we treat? - ✔✔hydration but NO antibiotics This vaccine may cause a febrile seizure in a 12 month year old due to fevers that may spike to 103 degrees - ✔✔MMR (measles component) A positive valgus stress test of the elbow indicates what? - ✔✔ulnar collateral ligament injury Cubital tunnel syndrome is a neuropathy of the ____________ caused by compression or traction as it passes through the cubital tunnel of the medial elbow. - ✔✔ulnar nerve Appropriate pharmacotherapy for someone going thru alcohol withdrawal? - ✔✔Chlordiazepoxide (want long lasting benzos) Cows milk is not recommended for infants under the age of what? - ✔✔12 months Only required screening in young women prior to starting birth control? - ✔✔BP check First line treatment of acute MS exacerbation - ✔✔Oral or IV steroids Patients often present with agitation and confusion, tachycardia, and elevated blood pressure, as well as a dry mouth. Treatment? - ✔✔Bento like lorazepam or diazepam~ serotonin syndrome What decreases the pain of a lidocaine injection? - ✔✔buffering with sodium bicarbonate What should we do in an asplenic patient with fever? - ✔✔immediately give antibiotics How do we give PPSV23 and PCV13 to an asplenic patient? - ✔✔8 weeks apart What do we give to asplenci patients under 5 y/o? - ✔✔2 doses of penicillin daily A 37-year-old graphic designer presents to your office with a history of several months of radial wrist pain. She does not recall any specific trauma but notes that it hurts to hold a coffee cup. Finkelstein's test is positive and a grind test is negative, and there is tenderness to palpation over the radial tubercle. Which one of the following would be most appropriate at this point? - ✔✔Rest and thumb spica wrist splint (she has de Quervain's tenosynovitis) Someone with an elevated WBC who is acutely ill with cellulitis should be treated with what? - ✔✔Vanc Patients with chronic illness, diabetes mellitus, cerebrospinal fluid leaks, chronic bronchopulmonary dysplasia, cyanotic congenital heart disease, or cochlear implants should receive how many doses of pneumococcal vaccines? - ✔✔2 Appropriate workup for infertility? - ✔✔Check luteal progesterone Hysterosalpingography after for patency U.S. Preventive Services Task Force (USPSTF) guidelines recommend that asymptomatic adults with sustained blood pressure >135/80 mm Hg be screened for what? - ✔✔DMII Leading cause of death in those with RA? Why? - ✔✔atherosclerotic heart disease (secondary to chronic inflammatory state) Two classes of drugs to treat OCD? - ✔✔TCAs SSRIs Treatment for postherpetic neuralgia? - ✔✔lidocaine patches A patient presents with a severe headache they have never had before that has lasted 3 hours. You order a non-contrast CT that is negative, next step? - ✔✔lumbar puncture to check for xanthochromia A 62-year-old male comes to your office as a new patient. He has a past history of a myocardial infarction and is currently in stage C heart failure according to the American Heart Association classification. His ejection fraction is 30%. Which one of the following medications that the patient is currently taking is potentially harmful and should be discontinued if possible? A. Diltiazem (Cardizem) B. Lisinopril (Prinivil, Zestril) C. Carvedilol (Coreg) D. Atorvastatin (Lipitor) - ✔✔A. Diltiazem negative inotropic activity First line therapy for a fecal impaction in a child? - ✔✔An oral osmotic agent such as polyethylene glycol 3350 (MiraLax) When should a child with head lice return to class? - ✔✔immediately only transmitted by head to head contact If a nonsmoker has blood tinged sputum what do we do? Smoker? - ✔✔Nonsmoker- Chest Xray Smoker- Chest CT Two main risk factors for esophageal adenocarcinoma? - ✔✔GERD Obesity Best medication to treat acute pylo? - ✔✔Cipro (fluorquinolones) asymptomatic man from iowa who has a milliary pattern of BB sized calcifications on chest Xray? - ✔✔Histoplasmosis Immune (idiopathic) thrombocytopenic purpura is an acquired immune-mediated disorder defined as isolated thrombocytopenia not found to have another cause. How do we treat it? - ✔✔Corticosteroids (then do a bone marrow biopsy to rule out a cancerous cause or find cause) Drug of choice for treatment of pertussis? - ✔✔Azithromycin Best initial screening for hereditary hemochromatosis? - ✔✔Ferritin and transferrin saturation Terminally ill cancer patients who receive palliative chemotherapy are less likely to what? - ✔✔Die at home (palliative chemotherapy is not good, more vents and more CPR) What do we do in the case of a diagnosed case of bacterial meningitis? - ✔✔Treatment and then prompt prophylaxis of family and close contacts Foul smelling stool makes you think what? - ✔✔Giardia Exudative process that causes pleural effusions? - ✔✔Pulmonary embolism (if LDH is above .67=exudative) Why don't we give a hormonal releasing IUD to someone with severe cirrhosis? - ✔✔Increases the risk of hepatocellulalr carcinoma Which is more successful a detox program or long term methadone/buprenorphine? - ✔✔Long term pharmacotherapy The umbilical cord usually has ______ arteries ______ veins - ✔✔2 1 How do we treat trochanteric bursitis? - ✔✔Corticosteroid injection What do we do in a patient with well controlled HTN and renal artery stenosis? - ✔✔continue monitoring their serum creatinine (CT or MRI if worsened and then stenting) Treatment of choice for community acquired pneumonia? - ✔✔Azithromycin A bite on the hand or that involves the lymphatics veins or arteries, what should be done? - ✔✔antibiotic prophylaxis Why is Lisinopril first line for ADPCKD? - ✔✔B/c of its renal protective affects Why don't we prescribe pseudophendrine or phenylephrine in the elderly? - ✔✔can interfere with BBs, raise BP, and cause urinary obstruction Three things that reduce iron absorption? - ✔✔Calcium coffee tea Two things that can falsely lower the A1C? - ✔✔hemolytic anemia and acute blood loss (you lose RBCs so you don't find glucose attached to them) he volume of distribution of water-soluble compounds such as digoxin is decreased in older patients, which means a __________ dose is required to reach a given target plasma concentration - ✔✔smaller middle-aged patient with resistant hypertension and hypokalemia - ✔✔Aldosterone secreting mass (measure peripheral aldosterone and then CT) The clinical triad of purpura, abdominal pain, and arthritis is classic for what? How do we treat it? - ✔✔Henloch Schonlein Purpura No treatment we give acetaminophen for relief of arthritic pain Infants should roll from prone to supine by ____ months of age and supine to prone by ____ months of age - ✔✔4 6 changes of the oral cavity and lips • polymorphous rash • bilateral nonpurulent conjunctivitis • changes in the extremities (erythema followed by desquamation) • cervical lymphadenopathy and fever for 4-5 days - ✔✔Kawasaki's disease (need an US to look for aneurysm) First line therapy for morning N in pregnancy? - ✔✔Vitamin B6 is recommended as first-line therapy When can we not give scopolamine patch for pregnant morning sickness? - ✔✔first trimester (trunk and limb deformities) Do we need to prophylax those with a pre-existing heart valve problem for dental procedures? - ✔✔No, not if they are stable only high risk candidates Best treatment for moderate triglyceridemia? - ✔✔fenofibrate Approximately 0.3% of patients taking __________ develop agranulocytosis, usually within the first 60 days of starting therapy. - ✔✔methimazole Pulsatile tinnitus, unilateral tinnitus, or tinnitus associated with asymmetric hearing loss is more likely to be associated with a pathologic cause and thus needs what that bilateral non-bothersome tinnitus does not? - ✔✔Neuroimaging is a syndrome marked by motor restlessness. - ✔✔akathisia 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. Dx? - ✔✔erythrasma What post uterine atony agent should in patients with asthma - ✔✔Carboprost Treatment for acute parotitis? - ✔✔augmentin Patient with asymptomatic aortic stenosis should be seen how often for an echo? - ✔✔Every 3-5 years If a child gets sick and then has lymph nodes that remain swollen hot and red they have _________. How do we treat it? - ✔✔lymphadenitis 4 weeks of antibiotics and observation Leading cause of human death worldwide? - ✔✔Ischemic heart disease What cause of hyperthyroidism will cause an uptake of radioactive iodine? - ✔✔Graves If the MAP of a patient is below 60 they meet criteria for septic shock, what is the first thing we do to raise BP? - ✔✔fluid resuscitation How do we calculate MAP? - ✔✔[(2 x diastolic)+systolic] / 3 After an acute trauma what do we think of in leg pain? - ✔✔Acute compartment syndrome (order a tissue pressure study) What testing is recommended prior to beginning pre-exospure prophylaxis for HIV with Truvada? - ✔✔creatinine clearance calculation hepatitis B antibody testing screening for sexually transmitted diseases pregnancy testing HIV antibody testing We treat this antibiotic with 60 days of oral fluorquinolones or doxycycline - ✔✔Anthrax Every patient with croup should receive what? - ✔✔single dose of dexamethasone What is recommended for women who are breast feeding the first few days after delivery? - ✔✔400 I/U/day of Vitamin D until baby is consuming 500 Ml of milk difference between scar and keloid? - ✔✔Keloid will expand beyond the site of the wound What should we monitor during testosterone? - ✔✔Erythrocytosis can occur so we need to monitor hematocrit Most common cause of resistant HTN in adults - ✔✔OSA Where do we place an injection in a patient with rotator cuff tendinitis? - ✔✔Subacromal space When do we give an intra-articular injection? - ✔✔Severe OA A skeletal survey is appropriate in a child 2 years of age or younger suspected of being what? - ✔✔physical abused Who do we test for HIV? - ✔✔all patients aged 15-65 years old If a patient has HTN after 37 weeks gestation what do we do? - ✔✔induce labor Pathognomonic for narcolepsy? - ✔✔cataplexy- paralysis with laughing What two medications do we normally give for narcolepsy? - ✔✔sodium oxybate to improve sleep Methyphenidate or another stimulant to keep the person awake Positive CCP indicates what disease? Sole therapy if you can only start one? - ✔✔Rheumatoid arthritis Methotrexate If the FVC is normal or decreased and the FEV1 is decreased, an FEV1/FVC ratio <0.7 means there is an __________ impairment - ✔✔obstructive If the FVC is decreased and the FEV1 is normal or decreased the ratio would be >0.7 an ___________ impairment is indicated - ✔✔restrictive Screening needed for women 11 weeks to 16 weeks pregnant? - ✔✔UA for asymptomatic bacteruria When do we allow patients to return to activity from a stress fracture? - ✔✔When they are symptom free and have a normal physical exam Patient with hematospermia should have what workup? - ✔✔STIs Prostate/PSA Testicular exam What medications can be used to treat irritable bowel syndrome? - ✔✔anticholinergics (amitriptyline) and SSRIs Most effective therapy for meniscus tear? - ✔✔Physical therapy (meniscectomy is not shown to be as helpful) Should we recommended antioxidant therapy? - ✔✔No, has proven to increase all cause mortality A 42-year-old male has symptoms of hypogonadism. Which one of the following should be ordered first? - ✔✔early morning serum testosterone What medication is proven to lower the risk of pre term pre-ecclampsia? - ✔✔ASA In a patient with asymptomatic gallstones what do we do? - ✔✔expectant management What is the best method to stop primary monosymptomatic enuresis? - ✔✔bed alarms (wake up and urinate) Patients with DM should receive what preventative therapy for cardiovascular protection? - ✔✔moderate intensity statin Preferred narcotic in patients with end stage renal disease? - ✔✔fentanyl _____________ is often preceded by minor trauma to the elbow followed by a nontender, boggy mass over the olecranon - ✔✔ascetic olecranon bursitis (compression dressing is treatment of choice, don't aspirate due to risk of infection) An ankle-brachial index (ABI) is considered normal between what two numbers? - ✔✔1-1.4 Values less than 1 indicate more severe peripheral artery disease Values greater than 1.5 indicate incompressible arteries (can't use) Only Ab shown to be effective in chemoprophylaxis of lyme disease? - ✔✔doxycycline symptoms of hypoparathyroidism - ✔✔refractory heart failure tetany seizures altered mental status stridor. __________ and _______ are useful in the diagnosis and treatment of narrow-complex supraventricular tachycardias - ✔✔vagal maneuvers adenosine Pediatric umbilical hernias normally proceed how? - ✔✔they repair on their own after 3-5 years Which one of the following medications is associated with a higher risk of death due to stroke or sudden cardiac death in patients with dementia? A. Diazepam (Valium) B. Fluoxetine (Prozac) C. Paroxetine (Paxil) D. Quetiapine (Seroquel) E. Venlafaxine - ✔✔Seroquel What medication should be started prior to a vascular surgery - ✔✔statin Describe what we find in SIADH? - ✔✔You inappropriately secrete ADH meaning you retain fluid and urinate out Na+, thus the serum osmolality will be low and the urine Na+ high -treat with fluid restriction In Bitamin B12 deficient patients what two things are normally elevated? - ✔✔methylmalonic acid and homocysteine levels If a patient has hyperkalemia and an abnormal EKG what do we give? - ✔✔IV calcium Best contraceptive option in someone waiting for a transplant - ✔✔IUD In patients with IBS what are two treatments to help global symptoms and reduce abdominal discomfort? - ✔✔SSRIs and TCAs First line therapy for GAD? - ✔✔SSRIs Low diffusing capacity of the lungs for carbon monoxide (DLCO) with normal spirometry indicates a disease process that disrupts gas transfer in the lungs without causing lung restriction or airflow obstruction such as ___________ - ✔✔PE Targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications - ✔✔Secondary prevention programs Benzodiazepines in the elderly run the electrolyte risk of what? - ✔✔Hyponatremia (messes with Na+ channels remember) α-adrenergic receptor antagonist and is recommended for the treatment of nightmares in posttraumatic stress disorder (SOR A) - ✔✔prozasin In a smoker with age related macular degeneration what is the best option? - ✔✔Smoking cessation (distorted grid lines on Amsler grid) In a patient with acute pancreatitis what feeding option is preferred? - ✔✔Continuous NG enteral nutrition Having multiple exposures on skin often not covered by clothing would be typical of ___________ - ✔✔bedbugs Definitions of CKD? - ✔✔eGFR <30 mL/min/1.73 m2 a urine albumin to creatinine ratio >300 μg/mg persistent acidosis or potassium imbalance non-iron deficiency anemia with a hemoglobin level <10 g/dL evidence of secondary hyperparathyroidism. In a patient with peripheral neuropathy and elevated serum protein what is the next step? - ✔✔serum protein electrophoresis Any bite or trauma involving a joint must get what? - ✔✔surgical consultation Confusion Assessment Method (CAM) is a ___________ diagnosis tool - ✔✔delirium The other tests listed, including the Mini-Mental State Examination, Mini-Cog, Montreal Cognitive Assessment, and Saint Louis Mental Status exam, test what? - ✔✔chronic baseline mental status not acute changes What musculoskeletal problem is improved (not just brief relief) with corticosteroid injections? - ✔✔trigger finger All children 9-11 y/o should be screened for which of the following? A. Anemia B. Diabetes mellitus C. Dyslipidemia D. HIV - ✔✔C. Dyslipidemia Initial management of a widened, regular, monomorphic QRS? - ✔✔adenosine _________________ accounts for a significant number of cases of failure to thrive, crib death, and recurrent pneumonia - ✔✔gastroesophageal reflux recurrent pneumonia, a low growth curve, a family history of sudden infant death syndrome, and normocytic anemia are all indicators of what in children? - ✔✔GERD Common remedy for childhood constipation? - ✔✔miralax (Polyethylene glycol) What two antibiotics do we give to all patients with SSA and pneumonia? - ✔✔3rd gen cephalosporins (regular coverage) Azithromycin (cover atypicals) Appropriate test to run in someone you suspect is vitamin D deficient? - ✔✔25-hydroxyvitamin D If someone has _________ we should increase their levothyroxine dose - ✔✔H. pylori or other GI problems What vitamin do we give to relieve peripheral neuropathy in TB patients? - ✔✔B6 (dice in sketchy) develop because of ulnar nerve compression in the upper extremity, leading to sensory paresthesias in the ulnar digits and intrinsic muscular weakness. - ✔✔cubital tunnel syndrome f atrial fibrillation is converted back to sinus rhythm, the likelihood of the patient staying in sinus rhythm is best predicted from the diameter of the _____________ - ✔✔left atrium Treatment of choice for outpatient management of a cancer induced DVT? - ✔✔lovenox (enoxaparin) A 36-month-old male has persistent deficits in social communication and interaction across multiple contexts. He displays restricted and repetitive patterns of behavior, interest, and activities. this is most consistent with what? - ✔✔autism spectrum disorder Antipyschotic shown to reduce aggressive behaviors in demented individuals - ✔✔aripiprazole A septic patient the glycemic goal is what? - ✔✔<180 Define oppositional defiant disorder - ✔✔angry/irritable mood argumentative/defiant behavior vindictiveness towards someone other than a sibling Conduct disorder is more severe than ODD why? - ✔✔behaviors are aggressive and towards animals and they may destroy or steal things functional dyspepsia may manifest as postprandial fullness or pain and burning in the epigastrium, how do we treat each? - ✔✔PPF: metochlopramide Pain: PPI or H2 Unlike radioactive iodine, ___________ has been shown to decrease the risk of development or progression of ophthalmopathy in Graves disease - ✔✔methimazole Accepted mood stabilizers used for maintenance therapy in patients with bipolar disorder include - ✔✔lithium valproate lamotrigine some atypical antipsychotics such as olanzapine, quetiapine, and risperidone indicates how a positive or negative test correlates with the likelihood of disease - ✔✔Likelihood ratio if the patient's endometrial stripe is >_______ you worry about endometrial cancer - ✔✔25mm he first-line pharmacologic agent for the treatment of alcohol withdrawal delirium is a benzodiazepine, such as ________ - ✔✔lorazepam (ativan) When can we tell an shorter adolescent they will grow taller in one year? - ✔✔Sexual maturity of 2 or 3 height is equal to bone age How to differentiate external hemorrhoids from anal fissures? - ✔✔external: can bleed with trauma but typically cause pain with thrombosis, independent of bowel movements fissure: pain during and after defecation, caused by passage of hard stool If someone comes in with MRSA bacteremia and we culture their blood how soon after, assuming they don't have endocarditis or a prosthetic valve or indwelling line, do we need to culture their blood? - ✔✔2-4 days later GLP-1 agonists are contraindicated in patients with what? - ✔✔thyroid cancer Coin rubbing is a traditional healing custom practiced primarily where? - ✔✔Southeast Asia If someone has a fasting blood glucose of 100-125 what do we do? - ✔✔bring them back in 1-2 weeks to test again (100-125 is impaired fasting blood glucose) When should iron therapy begin for premature infants who are breastfed? - ✔✔1 month of life A 46-year-old runner presents with left heel pain. The pain has been occurring mostly with running, but more recently it is painful with walking. On examination there is tenderness and a palpable nodule on the midsubstance of the left Achilles tendon. Best treatment? - ✔✔eccentric calf-strengthening exercises. In 65 year old patient with no comorbidities what is their target BP? - ✔✔<150 (all people 60 or older)