ABFM EXAM 2024-2025 ACTUAL EXAM 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALE, Exams of Nursing

Download ABFM EXAM 2024-2025 ACTUAL EXAM 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALE and more Exams Nursing in PDF only on Docsity! 1 child with head lice rx'd with shampoo permethrin still has nits in her can she go to school? - correct answeryes as long as continue home remedy, nit combing and repeat permethrin shampoo in 6 days is diverticular bleeding painful? - correct answerno - abdominal pains BP recommendation for >65 - correct answer150/90 young boy left hip pain afebrile ESR normal WBC normal Radiograph knee and hip normal dx? rx? - correct answertransient synovitis rx: nsaids rx for SVTs but short-term and llong term - correct answerCCB eg verapamil, diltiazem 16 yo fatigue on OCPs 2 low bleed on periods normal TSH normal Hct normal RBC count MCV <80 what lab test next? - correct answerHgb electrophoresis - check beta thalassemia Signs of ALS - mainly motor sx - correct answerasymmetrical weakness in legs, feet, ankles slurred speech trouble swallowing SOB wt loss mcc urge incontinence in elderly - correct answerdetrusor instability what diabetes medications are good for prevention of developing DM in pre- diabetes pt - correct answermetformin "alpha-glucosidase inhibitors (acarbose) orlistat 5 what meds do you start on - correct answercalcium and vit d supplements test for meniscus tears - correct answerthessaly 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 answerthe 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 answeralbuterol 10-15min before exercise does ankylosing spondylitis improve with exercise and activity? - correct answeryes also note: - pain worse in evening - stiffness worse in morning pt wwith ASCVD risk >7.5% should be started on? - correct answermoderate-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 answerPCV13 now and PPSV23 in 1 year mcc hearing loss in newborn - correct answergenetics 6 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 answerTreatment 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. pt took extra pill prescribed by psychiatrist PMH: depression normal RR, HR diaphoretic resting symmetrical tremor 4+ reflexes dx? - correct answerderotonin syndrome pt SOB 7 d-dimer is positive what test to order next? - correct answerCT 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 answerretinal detachment rx COPD exacerbations - correct answerPrednisone, 40 mg daily for 5 days pt vs ptt - correct answerProthrombin Time (PT) Partial Thromboplastin Time (PTT) employees with >50 employees need to have what for nursing mothers? - correct answerreasonable unpaid break time to express milk pt with episodic pains in rectum happening for years occur 3-6weeks sharp, cramp-like pain last 1-15min no GI sx PE normal dx? - correct answerproctalgia fugax lesion in forearm looks like actinic keratosis horn-like projection - correct answercutaenous horn 10 A ground-glass appearance Central calcification of the nodule A solid density - correct answerA ground-glass appearance others: >10mm upper lung location irregular borders no calcifications increasing size over time what HA1c cut off is used for managing elderly pt with DM - correct answerA1c 8 - 9 % most effective meds for fibromylagia - correct answerTCAs young boy still bedwets PE normal next step? - correct answerorder 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 11 Isosorbide dinitrate/hydralazine (BiDil) Losartan (Cozaar) Spironolactone (Aldactone) - correct answerspirinolactone don't add ARB - because never use ACEi with ARB exclusively BF babies need iron supplements from __ months? - correct answer4 months which of the following meds cause vit b12 def? Aspirin Enalapril Metformin Simvastatin Hydrochlorothiazide - correct answermetformin others: - h1 blocker - PPi should you screen for cervical cancer in pt with hysterectomy? - correct answerno age of CRC screen - correct answer50 - 75 pt with acute lumbar pain with radiculopathy no signs of cauda equina syndrome, cancer, infection or fracture 12 is imaging needed? - correct answerno rx: 6 weeks pain meds, PT all infants with down syndrome should be screened for? - correct answercardiac problems - echocardiogram vision - congenital cataracts; test with red reflex hearing thyroid hematologic feeding abnormaliies croup in 2yo child not in severe distress only mild disease rx? - correct answersingle dose oral corticosteroid croup in 2 yo child in distress lots of nasopharyngeal mucus severe disease 15 - bupropion - citalopram - duloxetine - nortriptyline - correct answerduloxetine pt with HTN wants nonpharmacologic intervention to manage BP - correct answermonitor 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 answerone 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? 16 - Replace his inhaled medications with nebulized alternatives - Replace his tiotropium with ipratropium (Atrovent) - Order home oxygen - Refer for outpatient pulmonary rehabilitation - correct answerPulmonary 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 answermetformin - helps with abnormal menstruation diffuse ST elevations on EKG acute sharp chest pain relieved by leaning fwd 17 rx? - correct answerpericarditis 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 rx? - correct answersurgical debridement pt with thyroid nodule >1cm next step? - correct answermeasure TSH if results abnormal, do a radionuclide thyroid scan >=2 cases of influenza A (H1N1) in a nursing home is an outbreak what is management? - correct answerChemoprophylaxis with appropriate medications for all residents 2day old infant with flesh-colored papules with an erythematous base located on the face and trunk, containing eosinophils. what to do? - correct answerobservation only benign eruption in newborns self-limiting 20 5 - 85th percentile 85 - 94th percentile >95 percentile - correct answer2-18 yo BMI <5th percentile - underwt 5 - 85th percentile - nml 85 - 94th percentile - overwt >95 percentile - obese < 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 21 D) It is rarely associated with bacterial co-infection - correct answerIt 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 answeramoxicillin adolescent - azithromycin to cover m. pneumonaie non-obese 2-8 yo child with OSA rx? - correct answeradenotonsillectomy - peak tonsil growth at this age pt with CKD - low ferritin - low hgb - low hct - MCV <80 rx? - correct answeriron supplement - Ferrous sulfate orally adolescent child (teens) 22 pain in groin or anterior thigh or referred pain to knee + limping dx? - correct answerslipped capital femoral epiphysis pt with PSD should be started on ____ or ptesent CVD eg MI, stroke - correct answeraspirin clopidogrel older adult + FABER +FADIR hip pain dx? - correct answerhip labral tear FABER and FADIR detect intra-articular pathology what are patient oriented outcomes as it related to potential effects of drugs? - correct answerall-cause mortality morbidity symptoms QOL vaccine with increase risk of febrile seizures for children - correct answermmr facts on influenza vaccine The live attenuated intranasal influenza vaccine is recommended for healthy non- pregnant persons 2-49 years of age. 25 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 answerA 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 rx acute flare up/exacerbations of MS - correct answersteroids rx for serotonin syndrome - correct answerbenzos - lorazepam, diazepam if non-responsive to benzos - cyproheptadine dx of sepsis severe sepsis septic shock - correct answerdx of sepsis - high WBCs 26 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 - 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 27 E) Lung cancer - correct answerCAD what do you advice parents of a 5yo with uncomplicated femoral anteversion (in- toeing) - correct answerobservation 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 answerrepetitive exposure to fearful stimuli rx postherpatic neuralgia - correct answerlidocaine patches capsaicin cream/patches gabapentin po pregablin po amitriptyline po elderly pt intense retro-orbital HA + neck pain high BP HA continue for hours 30 dx? rx? - correct answeridipathic (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 answerTerminally ill cancer patients who receive palliative chemotherapy are are less likely to die at home 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 answerOral prednisone for 5 days tamoxifen vs raloxifene - breast 31 - bone - endometrium - correct answertamoxifen - breast: estrogen antagonist - bone: estrogen agonist - endometrium: estrogen agonist raloxifene - breast: estrogen antagonist - bone: estrogen agonist - endometrium: estrogen antagonist CI for OCPs - correct answerAge ≥35 years and smoking ≥15 cigarettes per day ●Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension) ●Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) ●Venous thromboembolism ●Known thrombogenic mutations ●Known ischemic heart disease ●History of stroke 32 ●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 answerhx breast cancer hx liver cancer suspected pregnancy acute pelvic infection severe distortion of uterine cavity what can be given to decrease nighttime cough and improve sleep in children (>1 YEAR)? - correct answerhoney - do not give to children <1yr old how many arteries and vein on umbilical cord - correct answer2 arteries - originate from internal iliac a 1 vein 35 dx? rx? - correct answeracute laryngitis symptom relief - most likley viral FEV/FVC ratio in obstructive vs restrictive lung disease - correct answerobstructive <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) C) Omeprazole (Prilosec) D) Solifenacin (Vesicare) E) Nitrofurantoin (Macrodantin) - correct answernitrofurantoin other drugs that cause ILD: - amiodarone all preg women should be screen for ___ at 11 to 16 weeks - correct answerasymptomatic bacteriuria 36 - UA and culture signs of autism - correct answerdelayed 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 answerafter normal physical exam of the tibia most stress fractures heel in 6 - 10 weeks 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 37 what next? - correct answerget 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 answerTCA 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 D) Inactivated quadrivalent influenza vaccine - correct answerrecombinant trivalent influenza vaccine rx for PT with degenerative tear of meniscus A) Referral for meniscectomy B) Corticosteroid injection C) Hylan GF 20 (Synvisc) injection D) Continued physical therapy E) A knee brace - correct answerPT 40 A) Amoxicillin B) Ceftriaxone (Rocephin) C) Cefuroxime axetil (Ceftin) D) Doxycycline E) Clarithromycin (Biaxin) - correct answerdoxycycline 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 answerapply aloe, honey, lotion initial screening for hemochromatosis A) Serum transaminases 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 answerFerritin and transferrin saturation - will be elevated then check HFE complication of hypoparathyroidism 41 A) somnolence B) low vitamin D C) muscle flaccidity D) hyperkalemia E) refractory heart failure - correct answerhypocalcemia - refractory heart failure - muscle twitch - muscle spasm/ tetany - seizures - altered mental status - stridor rx options for narrow complex SVTs - correct answeradenosine vagal maneuvers which psychosis drug are assoc with high risk of death due to stroke and cardiac arrest in elderly - correct answer2nd generation anti-psychotics eg quietapine The most common source of chest pain in children is A) pulmonary B) cardiac C) musculoskeletal D) gastroesophageal E) psychogenic - correct answermsk <10mm hyperplastic polyp in colon 42 when to repeat next screen - correct answer10 yrs who should be screened for Hep B infection - correct answerPatients 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 In the United States the most common form of child abuse is A) physical abuse B) emotional abuse C) sexual abuse D) neglect - correct answerneglect first dx test for pt with hyperkalemia A) A urinalysis B) A CBC 45 A) Diverticulitis B) Ulcerative colitis C) Crohn's disease D) Colon cancer E) Osteoporosis - correct answerosteoporosis - 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 answertransvaginal ultrasonography severity of anorexia nervosa is based on which one of the following? 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 answerBMI >17 mild 16 - 16.9 moderate 15 - 15.9 severe 46 <15 extreme conditions that increase risk latent TB progress to active disease - correct answerlung cancer DM alcoholism immunosuppression silicosis when is the only time to give pps antibiotics to prevent bacterial endocarditis with dental/GI procedures - correct answerprosthetic valve hx endocarditis heart transplant pt that develop valvular disease 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 answermaternal precelampsia 47 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 answerC) Erythrasma pt delivers placenta and begins to bleed....lead to soft boggy uterus, what is this? - correct answeruterine atony and postpartum hemorrhage these drugs rx uterine atony and postpartum hemorrhage A) Carboprost (Hemabate) B) Methylergonovine C) Misoprostol (Cytotec) D) Oxytocin (Pitocin) when are carboprost and methlegonovine CI - correct answercarboprost - CI in asthma 50 D) Cefdinir, 14 mg/kg/day for 10 days E) Ciprofloxacin (Cipro), 10-20 mg/kg for 7 days - correct answerAmoxicillin, 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 answerinhaled 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 answerspirometry 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. 51 dx? A) Appendicitis B) A hematoma within the abdominal wall musculature C) Diverticulitis D) Pelvic inflammatory disease E) An ovarian cyst - correct answerhematoma 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 answerin between normal cognition and dementia Objective evidence of memory decline + 52 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 answernothing 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) 55 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 answerAdding rapid-acting insulin at dinner DM pt with high glucose levels before dinner currently on lantus at night 56 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 answerAdding 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 answerreferral found <10mm hyperplastic polyp 57 next colonoscopy in ___ years - correct answer10 years pt with hypothyroidism wants a more "natural" rx regimen while pregnant 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 answercontinue 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 answercrohns - erythema nodosum (shins) - anemia 60 4+ proteinuria next steps? A) Start labetalol (Trandate) and discharge home on bed rest with close follow-up B) Start magnesium sulfate and induce labor now C) Start magnesium sulfate, administer corticosteroids, and induce labor in 48 hours 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 answerStart 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? 61 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 answerAmoxicillin/clavulanate (Augmentin), 90 mg/kg/day for 10 days typmanostomy - 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 62 D) Stationary bicycling E) Resistance training - correct answerResistance 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 E) Hypersensitivity pneumonitis - correct answerPE - normal PFTs and low DLCO interstitial lung disease - restrictive PFT and low DLCO what do muscle strenght grades mean 65 A) Aspirin B) Clopidogrel (Plavix) C) Rivaroxaban (Xarelto) D) Intravenous tenecteplase (TNKase - correct answerrivaroxaban daily for 3 months preferred TB test for mexicans/immigrants who have been vaccinated with BCG - correct answerInterferon-gamma release assays which one of the following findings would denote the highest risk for death or myocardial infarction? A) New-onset angina beginning 2 weeks to 2 months before presentation B) Angina with hypotension C) Angina provoked at a lower threshold than in the past D) Increased anginal frequenc - correct answerAngina with hypotension supraclavidualr lymph node enlarged + painless jaundice + palpable nontender gall bladder 66 dx? - correct answerpancreatic 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 answercrush 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 D) Discontinue the amoxicillin and note amoxicillin as a potential allergy in her record - correct answerDiscontinue the amoxicillin and note amoxicillin as a potential allergy in her record 67 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 answerDuloxetine - 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 answercheck syphillis When should preg women get Tdap A) Post partum B) At this visit 70 Which one of the following medications is most appropriate for this patient? A) Amoxicillin/clavulanate (Augmentin) B) Trimethoprim/sulfamethoxazole (Bactrim) C) Cefuroxime (Ceftin) D) Doxycycline E) Azithromycin (Zithromax) - correct answerCefuroxime (Ceftin) Which one of the following is most likely in a depressed elderly patient? A) Suicidal ideation B) Somatic symptoms C) Depressed mood D) Preoccupation with guilt - correct answerSomatic symptoms In addition to cool compresses and antihistamines for the itching, which one of the following is the best treatment option for contact dermatitis (rash days after being in woods)? A) Triamcinolone, 20 mg intramuscularly as a single dose B) A 6-day oral methylprednisolone (Medrol) dose pack, starting at 24 mg C) A 7- to 10-day course of topical halobetasol propionate (Ultravate), 0.05% ointment D) A 7- to 10-day course of topical mupirocin (Bactroban) 2%, after decompression of vesicles and bullae E) A 10- to 14-day tapering course of oral prednisone, starting at 60 mg - correct answer 71 pt on ranitidine, aspirin and acetaminophen what of the following other drugs in combinations with ones listed above causes vit b12 def? A) Hydrochlorothiazide B) Lisinopril (Prinivil, Zestril) C) Amlodipine (Norvasc) D) Simvastatin (Zocor) E) Omeprazole (Prilosec) - correct answeromeprazole and ranitidine 1st line rx for menstrual irregularity, hirsutism and acne in PCOS? - correct answerOCPs 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 72 D) Intramuscular glucagon E) Intramuscular betamethasone sodium phosphate/betamethasone acetate (Celestone Soluspan) - correct answergive IM glucagon - antidote for b-blocker 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 answerpreterm 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 75 A) Seizures B) Heart failure C) Ventricular dysrhythmias D) Hypertension - correct answerseizures - lowers seizure threshold pt with acute dysuria, frequency and urgency no hematuria, fever, nausea or back pain no vaginal itching or discharge Treatment for this patient should be based on A) her reported symptoms B) the presence or absence of suprapubic tenderness on examination C) the presence or absence of leukocyte esterase on a urine dipstick D) findings from a mid-stream urine culture E) findings from urine microscopy - correct answerreported sx - has acute cystitis pt with thyroid nodule on PE 76 check TSH level - normal or high what next? - correct answerthink: low functioning thyroid or normal functioning do bx if nodule >1cm do clinical f/u if nodule <1cm pt with thyroid nodule on PE check TSH level - low what next? - correct answerthink: 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 answerstatin 77 - 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 answertylenol avoid nsaids - nephrotoxic 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 answerLH, FSH and TSH levels A 2-year-old female is brought in by her father for evaluation of a cough. Her cough started 10 80 afebrile, normal tympanic membranes, no pharyngeal drainage Cv normal PULM normal rx? - correct answersupportive - pt has laryngitis pt with sudden vision loss Which one of the following would make you suspect retinal vein occlusion as the cause of her sudden visual loss? A) An afferent pupillary defect in the contralateral eye B) Right eye redness C) Tortuous retinal veins on funduscopic examination D) Macular drusen on funduscopic examination - correct answertortous veins - cotton wool spots rx radial fracture A) A long arm posterior splint B) A radial gutter splint 81 C) A sugar-tong splint D) A thumb spica splint E) An ulnar gutter splint - correct answerimmobilization 4-8weeks - sugar tong splint or - short arm cast what does not work for IBS A) Fiber B) Probiotics C) Antispasmodics D) Antidepressants - correct answerfiber what works - probiotics, antispasmodics, antidepressants, peppermint oil Which one of the following is associated with the use of stimulant medications for attention-deficit disorder in adults? A) Lower success rates compared to nonstimulant medications B) Weight gain C) A low risk of medication abuse D) Serious adverse cardiovascular events E) Increases in blood pressure - correct answerincrease high BP aggravate psychosis, tics In the first 24 hours after his stroke, starting treatment to control his blood pressure is 82 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 answer220/120 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 answerHCTZ - loss of benefit within 4 months of discontnuation Plan-Do-Check-Act (PDCA) describes which one of the following? 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 answerThe cycle of continuous quality improvement 85 tenderness, a diffuse maculopapular rash, muscle tenderness, and petechiae on his extremities. labs: - low WBC - low platelets - high hematocrit - high AST and ALT (same range) - normal bilirubin - no jaundice A) Hepatitis A B) Yellow fever C) Dengue fever D) Typhoid fever E) Influenza - correct answerdengue - supportive care - avoid NSAIDs and aspirin due to anticoagulation properties - avoid via bed nets, misquito repellents, protective clothing note: yellow fever present same way but with jaundice and high bilirubin Stretching has NO demonstrable benefit for which one of the following? A) Hamstring strain B) Chronic neck pain C) Joint contracture 86 D) Osteoarthritis E) Rehabilitation post knee replacement - correct answerjint contracture Which one of the following is most appropriate in the management of frostbite? A) Complete surgical debridement of hemorrhagic blisters B) Rapid rewarming with dry heat and warm blankets C) Withholding analgesics to ensure accurate assessment D) Vigorously rubbing affected tissues to restore circulation E) Leaving simple, non-tense areas of clear blistering intact - correct answerLeaving simple, non-tense areas of clear blistering intact rapid warming is done in whirlpool bath with antiseptic rx polymyagia rheumatica A) Oral dexamethasone, 8 mg twice a day B) Oral methylprednisolone (Medrol Dosepak), taper 24 mg to 0 mg over 7 days C) Oral prednisolone (Orapred), 60 mg daily D) Oral prednisone, 15 mg/day E) Intravenous methylprednisolone, 120 mg every 6 hours - correct answerOral prednisone, 15 mg/day with a slow taper over 1-2years A 46-year-old perimenopausal female complains of hot flashes, which are very troubling to her. She would like treatment for these symptoms, but has a history of deep vein thrombosis while taking oral contraceptives. 87 Which one of the following treatments has evidence of benefit for her symptoms with the least potential for causing deep vein thrombosis? 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 answerSSRI 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 answerIV 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