ABFM In training exam pearls 2022 COMPLETE SOLUTION, 100% proven pass rate.

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 activitymodification, 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 shipPolymyalgia 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 therapieswhat 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? - ✔✔Moh's surgery patients who no depression but have alcohol use disorder, what med is the best? - ✔✔Acamprosate, zofran also may help only use SSRI / SNRI if co-existing depression Pseudofolliculitis barbae - ✔✔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 - ✔✔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 systemic symptoms, and no signs of acute infection or inflammation. Treatment initially consists of avoiding recurrent trauma byprotecting the area with an elbow pad and not leaning on it, as well as cryotherapy, compression of the affected area, and over-the-counter analgesics. No XR or joint aspiration needed unless suspecting fracture or concern about infection which anticoagulant most effective in cancer patients - ✔✔Lovonox / heparin Lithium toxicity - ✔✔-Tremor, hypothyroidism, polyuria (causes nephrogenic diabetes insipidus), teratogenesis. -Causes Ebstein anomaly in newborn if taken by pregnant mother. -Narrow therapeutic window requires close monitoring of serum levels. -Almost exclusively excreted by kidneys; most is reabsorbed at PCT with Na+. Thiazide use is implicated in lithium toxicity in bipolar patients. chronic toxicity Chronic toxicity often presents with signs and symptoms related to the gastrointestinal tract (nausea, vomiting, and diarrhea, which can further worsen toxicity), heart (arrhythmias and conduction delays), and central nervous system (coarse tremors, ataxia, agitation, and confusion). what med has proven benefit for chronic tension headaches? - ✔✔TCAs! Try Amitryptyline! who should get MRI of breast? - ✔✔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 - ✔✔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 chestradiograph or CT, serum precipitating antibodies to Aspergillus fumigatus, and elevated Aspergillus IgEand/or IgG-specific antibodies. leading cause of cancer death in men? - ✔✔lung cancer leading cause of cancer death in women? - ✔✔lung cancer what med can you use with buprenorphine to reduce stress related opiod cravings and increase abstinence? - ✔✔Clonidine diagnosis of cushing syndrome - ✔✔- 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! start aspirin at what ASCVD risk score? - ✔✔10% class early sign of muscle dystrophy? - ✔✔head lag when sitting up polyhydramnios - ✔✔Excessive amniotic fluid; associated with fetal gastrointestinal malformations and neurologic disorders - tracheoesophageal fistula and anencephaly (underdeveloped brain and incomplete skull)-AFI > 24 -Causes =anencphaly, hydrops, esophageal atresia, and maternal alpha-thal oligohydramnios - ✔✔too little amniotic fluid AFI < 5 causes: posterior urethral valves, renal agenesis, polycystic kidney disease, fetal growth restriction, fetal death at what cobb angle do you refer to specialist for scoliosis? - ✔✔> 20, then higher risk of progression and complications >50 = respiratory compromise when melatonin and doxepin fail for insomnia, what can you use next? - ✔✔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 - ✔✔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 10-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 - ✔✔doxycycline diarrhea occurring after ileal resection due to chrohns disease often caused by? - ✔✔increased bile acid in stool (bile acid diarrhea - BAD); tx with cholecystarmine alzheimer's medication with increased risk of bradycardia - ✔✔Donepezil (aricept)patient on valproic acid comes in with altered mental status, why? - ✔✔Valproic acid causes of hyperammonia - have to treat with lactulose Psychogenic tremor - ✔✔abrupt onset, spontaneous remission, changing characteristics, and extinction with distraction. when should you taper antipsychotics on geriatric patients - ✔✔when sxs are in remission for > 3 months, taper w/ goal of stopping only thing approved for traveler's diarrhea - ✔✔hand wash frequently short course of azithromycin in case she develops it ptyriasis rosea and pregnancy risk - ✔✔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? - ✔✔annual eye exam; can be asx, and can lead to vision loss easy way to know that patient does not have capacity - ✔✔gives inconsistent answers to questions especially r/b/i initial test to see if patient has pulmonary HTN - ✔✔echocardiogram Pes Anserine Bursitis - ✔✔is an inflammation of the bursa located between the shinbone (tibia) and three tendons of the hamstring muscle at the inside of the knee. It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee. -caused by repetitive use when to consider starting patient on naloxone when on opioids? - ✔✔MME > 50! not 90; one shouldn't go over 90 due to significant increase in risk of adverse effectsCharcot neuroarthropathy - ✔✔THIS = noninfective bone & joint destruction that occurs in a wellperfused and insensate foot (commonly in obese diabetics) Dx - XR first, then MRI if needed