AAFP - Review of Board Review-With 100% verified solutions-2023-2024, Exams of Nursing

Download AAFP - Review of Board Review-With 100% verified solutions-2023-2024 and more Exams Nursing in PDF only on Docsity! 1 AAFP - Review of Board Review-With 100% verified solutions-2023 Absolute contraindications to electroconvulsive therapy (ECT) There are no absolute contraindications to ECT Treatment of community acquired pneumonia in infants and children - Diagnosis of community-acquired pneumonia is mostly based on the history and physical examination - Pneumonia should be suspected in any child with fever, cyanosis, and any abnormal respiratory finding in the history or physical examination - Outpatient antibiotics are appropriate if the child does not have a toxic appearance, hypoxemia, signs of respiratory distress, or dehydration - High-dose amoxicillin is the drug of choice Current practice is to introduce solid foods into the diet at what age for normal term infants 4-6 months of age as the extrusion reflex disappears by the age of 4 months Treatment of midshaft posteromedial tibial stress fractures An air stirrup leg brace (Aircast) Most appropriate test to screen for late-onset male hypogonadism Total testosterone Treatment of pediatric HSV-1 infection Acyclovir suspension Most accurate maneuver for detecting an ACL tear 2 - Lachman test (sensitivity 60%-100%, mean 84%), - Anterior drawer test (sensitivity 9%-93%, mean 62%) - Pivot shift test (sensitivity 27%-95%, mean 62%) Diagnosis of multiple myeloma is based on Evidence of myeloma-related end-organ impairment (hypercalcemia, renal failure, anemia, skeletal lesions) in the presence of M protein, monoclonal plasma cells, or both Findings are typical of femoral neuropathy - History of weakness of the lower left leg, giving way of the knee, and discomfort in the anterior thigh - Femoral neuropathy is a mononeuropathy commonly associated with diabetes mellitus Women who use low-dose estrogen oral contraceptives have a 50% lower risk of cancer of the: Ovary Clinical hallmarks of polymyalgia rheumatica - Pain and stiffness in the shoulder and pelvic girdle - Dramatic response to corticosteroids 3 subtypes of frontotemporal dementia - Behavioral variant - Semantic dementia - Progressive nonfluent aphasia 5 - Bleomycin, cyclophosphamide, Mitomycin - Bromocriptine - Methotrexate - Minoxidil Treatment of tachycardia w/ history of Wolff-Parkinson-White syndrome Procainamide Is doxycycline contraindicated in pregnancy? Yes, in the 2nd and 3rd trimesters due to permanent discoloration of tooth enamel Will steady extra caloric intake result in weight gain indefinitely? No, weight will increase to a certain point and then become constant Initial medical management of asthma Low-dose inhaled corticosteroid daily w/ SABA as needed Name some tumor necrosis factor inhibitors & testing required prior to initiation - Infliximab, adalimumab, certolizumab pegol, golimumab - Screen for TB, HBV, HCV Tests to detect HCV antibody & determine active from past infection 6 - Detection: enzyme immunoassay - Confirmation: recombinant immunoblot assay - Active/past infection: RNA polymerase chain reaction Precautions to be initiated for patient with MRSA infection - All staff, visitors, and nursing-home residents should observe strict handwashing practices - Barrier precautions for wounds & medical devices Procedures for which metformin should be withheld & consequences of not doing so - Anything that causes a reduction in kidney function, such as pyelography, angiography - Lactic acidosis Guidelines on combination therapy for nursing-home acquired pneumonia Combination therapy consisting of: 1. Antipseudomonal cephalosporin (cefepime, ceftazidime) or Antipseudomonal carbapenem (imipenem, meropenem) or Extended-spectrum ß-lactam/ß-lactamase inhibitor (piperacillin/tazobactam) 2. Antipseudomonal fluoroquinolone (levofloxacin, ciprofloxacin) or Aminoglycoside (gentamicin, tobramycin, amikacin) 3. Anti-MRSA agent (vancomycin, linezolid) 7 SSRI use in pregnancy No significant risk of congenital anomalies from SSRI use in pregnancy, except for paroxetine (↑ risk of congenital cardiac malformations w/ 1st trimester exposure) Classic presentations of the following: - pyloric stenosis - choledochal cyst - Meckel's diverticulum - intussusception - intestinal malrotation - Pyloric stenosis: palpable mass that develops b/w 4-6 weeks of age - Choledochal cyst: classic triad of RUQ pain, jaundice, palpable mass - Meckel's diverticulum: painless lower GI bleeding in infants - Intussusception: paroxysms of colickyl abdominal pain, palpable mass in ~2/3 of patients - Intestinal malrotation: bilious vomiting w/ in first 4 weeks of life Teriparatide indications Treatment of severe osteoporosis, for patients with multiple osteoporosis risk factors, or for patients with failure of bisphosphonate therapy Most likely infectious agent for acute dyuria, frequency, pyuria with no associated hematuria, flank pain, suprapubic pain, or fever, showing no growth/insignificant bacterial growth on midstream urine culture Sexually transmitted urethritis caused by: - C. trachomatis 10 - ESR Typical presentations of: - Staphylococcal pyoderma - Acne neonatorum - erythema toxicum neonatorum - Staphylococcal pyoderma: vesicular, stain of vesicular content shows PMNs & clusters of gram+ bacteria - Acne neonatorum: closed comedones on forehead, nose, cheeks - Erythema toxicum neonatorum: macules, papules, pustules 2-3 mm in diameter sparing palms/soles, stain of pustular smear shows eosinophils Breast feeding is contraindicated with - HSV lesions on the breasts - Active maternal tuberculosis - Following administration/use of radioactive isotopes, chemotherapuetic agents, "recreational" drugs, certain prescription drugs Most common cause of erythema multiforme (>50% of cases) HSV is the most commonly identified cause of this hypersensitivity reaction Management of pyogenic tenosynovitis - Within 48 hours, antibiotics and splinting may prevent spread of the infection 11 - With more severe stages, surgical drainage and antibiotics - Delay in treatment can lead to ischemia of the tendons and damage to the tendon an sheath Contraindications to: - Metformin - Sitagliptin - Pioglitazone - Acarbose - Exenatide - Insulin glargine - Metformin: patients w/ chronic kidney disease/renal insufficiency (creatinine level ♀ ≥1.4 mg/dL, ♂ ≥1.5 mg/dL) - Sitagliptin: should not be added to sulfonylurea initially - Pioglitazone: cardiomyopathy (causes fluid retention), hepatic disease - Acarbose: cirrhosis, creatinine >2.0 mg/dL - Exenatide: creatinine clearance <30 mL/min - Insulin glargine: can be used in patients with renal disease at any stage, but the dosage may need to be decreased Seafood poisoning that requires more than just supportive treatment - Scombroid poisoning (tuna, mackerel, wahoo, bonito) 12 - Nonscombroid poisoning (mahi-mahi, amberjack, sardines, herring) - Pseudoallergic condition due to high levels of histamine/saurine from bacterial catabolism of histidine - Symptoms include flushing of the skin, oral paresthesias, pruritus, urticaria, nausea, vomiting, diarrhea, vertigo, headache, bronchospasm, dysphagia, tachycardia, and hypotension - Therapy should be the same as for allergic reactions/anaphylaxis Postural orthostatic tachycardia syndrome (POTS) - Definition - Symptoms - Treatment - Definition: rise in heart rate >30 beats/min or by a heart rate >120 beats/min within 10 minutes of being in the upright position - Epidemiology: most prevalent in white females between the ages of 15 and 50 years old - Symptoms: position-dependent headaches, abdominal pain, lightheadedness, palpitations, sweating, and nausea - Treatment: encourage adequate fluid and salt intake, initiate regular aerobic exercise combined with lower-extremity strength training, and use of β-blockers Risk factors for abdominal aortic aneurysm - Cigarette smoking (5X ↑) - Hypertension - White race 15 - Combination therapy with a diuretic and an ACE inhibitor as this combination has been clinically shown to reduce the risk of recurrent stroke Activation of sympathetic branch of ANS will cause what to the following in regards to the cardiovascular system: - Heart rate - Coronary flow rate - Metabolic demand - Contractility of cardiac myocytes - PR interval - Heart rate: ↑ - Coronary flow rate: ↑ - Metabolic demand: ↑ - Contractility of cardiac myocytes: ↑ - PR interval: ↓ Most effective topical therapies that have the fewest adverse effects in the treatment of chronic plaque psoriasis - High-potency corticosteroids > Vitamin D - Corticosteroids had fewer local reactions vs. Vitamin D Most effective adjunctive therapies in the treatment of unipolar depression resistant to single-agent antidepressants Lithium > low-dose T3 > atypical antipsychotic (olanzapine) 16 Recommendation when proteinuria is noted on a dipstick and the history, examination, full urinalysis, and serum studies suggest no obvious underlying problem or renal insufficiency? Urine protein/creatinine ratio Most appopriate treatment for patients who present with acute cervical radiculopathy (neck pain w/ radiation, numbness/tingling, +Spurling's maneuver) and normal radiographs Conservative treatment w/ NSAIDs as vast majority of patients w/ cervical radiculopathy improve without surgery Clinical clues to diagnosis of malaria, peripheral blood smear findings, & treatment - Clinical clues: recent travel history, a prodrome of delirium or erratic behavior, unarousable coma following a generalized convulsion, fever, and a lack of focal neurologic signs in the presence of a diffuse, symmetric encephalopathy - Peripheral blood smear: normochromic, normocytic anemia w/ Plasmodium falciparum trophozoites & schizonts involving erythrocytes, diagnostic of cerebral malaria - Treatment: intravenous quinidine gluconate Define the following: - Apraxia - Agnosia - Aphasia - Astereognosis 17 - Apraxia: patient understands request, unable to perform task when asked, may perform it after a time delay - Agnosia: inability to recognize previously familiar sensory input, and is a modality- bound deficit - Expressive (Broca's) aphasia: language disorder, and expressive aphasia is a loss of the ability to express language - Astereognosis: ability to recognize objects by palpation in one hand but not the other Indications for consideration of cesarean delivery without a trial of labor If estimated fetal weight is: - 4500 g in a mother with diabetes mellitus - 5000 g in the absence of diabetes Intertrigo Cutanenous erythrasma - Intertrigo: inflammation of skinfolds caused by skin-on-skin friction, common on opposing cutaneous or mucocutaneous surfaces Secondary cutaneous bacterial/fungal infections are common complications - Cutanenous erythrasma: Corynebacterium minutissimum infection of interweb & intergluteal areas, crural folds, axillae, or inframammary regions presenting as small reddish-brown macules that may coalesce into larger patches with sharp border - Treatment of intertrigo complicated by erythrasma: topical/oral erythromycin 20 - Incretin mimetics - Nonsulfonylureas (-glinides): act on portion of sulfonylurea receptor to stimulate insulin secretion - Thiazolidinediones (-glitazone): ↓ insulin resistance - ɑ-glucosidase inhibitors (Acarbose): prevents breakdown of complex carbohydrates into monosaccharides delaying absorption of carbohydrates but does not affect absorption of glucose - DPP-IV inhibitors (-gliptins): inhibits enzyme responsible for breakdown of incretins (GLP-1, GIP) - Incretin mimetics (Exenatide): stimulate insulin secretion in glucose-dependent fashion, slow gastric emptying, may promote satiety Most effective intervention for smokeless tobacco cessation - Behavioral interventions (telephone counseling, dental examination) - Mint snuff, bupropion, nicotine replacement did not show any significant benefit Treatment of autoimmune hypothyroidism w/ history of coronary artery disease - Replacement therapy w/ levothyroxine at a slow rate (25 μg/daily for 6 weeks, increasing the dosage by 25 μg increments as needed based on TSH levels) - Rapid replacement would ↑ metabolic rate & myocardial oxygen demand too quickly, which can precipitate complications of CAD - Stopping a β-blocker is also likely to ↑ the risk of complications of CAD 21 Operative vaginal delivery Refers to a delivery in which the operator uses forceps or a vacuum device to extract the fetus from the vagina Vacuum-assisted delivery vs. forceps delivery vs. spontaneous vaginal delivery - ↑ risk of neonatal cephalhematoma, retinal hemorrhage, shoulder dystocia vs. forceps delivery - ↓ soft tissue trauma vs. forceps delivery - ↑ incidence of severe perineal laceration vs. spontaneous vaginal delivery Best initial imaging study for acute pelvic pain in women Transvaginal ultrasonography Next step for patient complaining of blood diarrhea, abdominal cramping due to Escherichia coli O:157 - Monitor renal function due to 10-15% risk of developing hemolytic uremic syndrome (HUS) secondary to her infection - Close contacts are at risk for secondary infection USPSTF recommended screening for sexually active adolescent females Chlamydia infection Most appropriate medication for treatment of depression & weight loss Mirtazapine 22 - Has serotonergic & noradrenergic properties and is associated w/ increased appetite & weight gain - Useful for patients with insomnia & weight loss Effects of hydrochlorothiazide & losartan on serum uric acid levels - Hydrochlorothiazide: ↑ - Losartan: ↓ Hemoglobin level w/ best predicted outcomes in patient's with CKD w/ chronic anemia - 10-12 g/dL - Patients w/ hemoglobin levels targeted to normal ranges did worse (↑ incidence of stroke, heart failure, death) than those who had hemoglobin levels of 10-12 g/dL Vocal cord dysfunction - Idiopathic disorder commonly seen in patients in their 20s-30s in which the vocal cords partially collapse or close on inspiration - Symptoms include episodic tightness of the throat, a choking sensation, shortness of breath, & coughing - Symptoms are worse with inspiration than with exhalation, & inspiratory stridor during the episode may be mistaken for the wheezing of asthma - Pulmonary function tests (PFTs) are normal, with the exception of flattening of the inspiratory loop, which is diagnostic of extra-thoracic airway compression - Treated with speech therapy, breathing techniques, reassurance, & breathing a helium-oxygen mixture (heliox)