ABFM In Training Exam Pearls With 100% Correct And Verified Answers 2024, Exams of Advanced Education

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ABFM In Training Exam Pearls With 100% Correct And Verified Answers 2024 Pre-exposure prophylaxis (PrEP), what meds, and what do you have check first? - Correct Answer-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! - Correct Answer-120 minutes time limit from onset of MI to balloon time - Correct Answer-should get it done w/in 12 hours Absolute contraindications to Fibrinolysis - Correct Answer-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 - Correct Answer-Acute inflammation of the gallbladder wall Patient with pulmonary HTN due to left heart failure, can they have vasodilators (PDE5?) - Correct Answer-NO! can make things worse -maximize heart failure treatment! Sever's Diseaese - Correct Answer-Calcaneal apophysitis, also called Sever's disease, is a common cause of heel pain in young athletes, especially those who participate in basketball, soccer, track, and other sports that involve running. Typically the heel apophysis closes by age 15. Treatment options include activity modification, the use of ice packs and/or moist heat, stretching, analgesics, and orthotic devices. The use of therapeutic ultrasound on the active bone growth plates in children is contraindicated. in pressure ulcers what solutions to avoid, and what to use! - Correct Answer- 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 - Correct Answer-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 - Correct Answer-chronic pulmonary embolus Antibiotic ppx for dental procedures - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-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 - Correct Answer-Confusion Assessment Method (CAM) to diagnose adult ADHD, symptoms must be present before what age? - Correct Answer-Age 12 Complications of GERD in infants - Correct Answer-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" - Correct Answer-it's a south asian thing, kids have multiple red welts and superficial abrasions scattered on chest and upper back Dix-Hallpike maneuver - Correct Answer-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 - Correct Answer-Escitalopram (lexapro) herbal supplement with highest risk of drug interactions? - Correct Answer-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) - Correct Answer-better efficacy Peak effect of opioids - Correct Answer-oral 1 hr IM - 10 min Subq- 20-30 min when to start O2 on pts with COPD? - Correct Answer-when PaO2 < 60 antihypertensives that help with HTN associated with OSA - Correct Answer-diuretics - but spironolactone does the best job highest cure rate for basal cell carcinoma? - Correct Answer-Moh's surgery patients who no depression but have alcohol use disorder, what med is the best? - Correct Answer-Acamprosate, zofran also may help only use SSRI / SNRI if co-existing depression Pseudofolliculitis barbae - Correct Answer-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 - Correct Answer-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 by protecting 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 - Correct Answer-Lovonox / heparin Lithium toxicity - Correct Answer--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? - Correct Answer-TCAs! Try Amitryptyline! who should get MRI of breast? - Correct Answer-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 - Correct Answer-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 chest radiograph or CT, serum precipitating antibodies to Aspergillus fumigatus, and elevated Aspergillus IgE- and/or IgG-specific antibodies. leading cause of cancer death in men? - Correct Answer-lung cancer leading cause of cancer death in women? - Correct Answer-lung cancer what med can you use with buprenorphine to reduce stress related opiod cravings and increase abstinence? - Correct Answer-Clonidine diagnosis of cushing syndrome - Correct Answer-- 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? - Correct Answer-10% class early sign of muscle dystrophy? - Correct Answer-head lag when sitting up polyhydramnios - Correct Answer-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 - Correct Answer-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? - Correct Answer-> 20, then higher risk of progression and complications >50 = respiratory compromise when melatonin and doxepin fail for insomnia, what can you use next? - Correct Answer-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 - Correct Answer-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. If no suspicious changes or symptoms are present there are various options for treatment, including topical therapy with hydroquinone or retinoids, or ablative therapy with chemical peels, cryotherapy, intense pulsed light, or laser therapies.` Koilonychia (spoon nails) - Correct Answer-Central depression of the nail with lateral elevation of the nail plate associated with multiple systemic conditions such as iron deficiency, hypothyroidism, and systemic lupus erythematosus. drugs associated with osteoperosis - Correct Answer-antiepileptic drugs, long-term heparin, cyclosporine, tacrolimus, aromatase inhibitors, glucocorticoids, gonadotropin- releasing hormone agonists, thiazolidinediones, excessive doses of levothyroxine, proton pump inhibitors, SSRIs, parenteral nutrients, medroxyprogesterone contraceptives, methotrexate, and aluminum antacids signs on imaging that are likely malignant - Correct Answer-nonsolid "ground glass" appearance, a size >6 mm, noncalcified lesions, a lesion size or volume doubling time between 1 month and 1 year, and irregular or spiculated borders signs of imaging that are likely benign - Correct Answer-benign lesions include a lesion size <6 mm, concentric or "popcorn-like" calcifications, doubling times of <1 month or >2-4 years, dense solid-appearing lesions, and lesions with smooth regular borders immunotherapy available for what allergy to prevent complications? - Correct Answer- insect bites wasp stings ulnar collateral ligament disruption (skier's thumb) - Correct Answer-should be suspected in traumatic thumb injuries. It is important to recognize and treat this injury because it can lead to joint instability and a weak pincer grip if untreated. Initial treatment of UCL disruption involves immobilization of the affected thumb in a thumb spica cast or brace for 6 weeks. In the absence of an avulsion fracture, indications for referral to an orthopedic surgeon would include 35°-40° of joint opening or no end point on stress abduction testing. A Stener lesion (entrapment of the UCL outside of the adductor aponeurosis) would usually present with joint instability and a tender mass and would necessitate an orthopedic referral. what is higher in rural areas compared to urban areas? - Correct Answer-percentage of population age 65 and older Pyogenic flexor tenosynovitis - Correct Answer-usually develops 2-5 days after a penetrating hand injury. The flexor tendon sheath has a poor vascular supply and the synovial fluid is a prime growth medium for bacteria. Flexor tenosynovitis is a clinical diagnosis characterized by the four "Kanavel" signs: pain with passive extension, tenderness with palpation of the tendon sheath, flexed position of the involved finger, and fusiform swelling of the finger. Treatment includes prompt intravenous antibiotics and surgical debridement and irrigation. Flexor tenosynovitis requires urgent surgical consultation and treatment. Patients with suspected flexor tenosynovitis should be seen by a surgeon within 72 hours of symptom onset (SOR C). Oral antibiotics and splinting of the hand alone are insufficient treatments for the condition. Incision and drainage would also not be sufficient to clear the infection. Ordering MRI can unnecessarily delay surgical consultation, although the surgeon may obtain one to guide treatment. Praxis - Correct Answer-practical action that is taken on the basis of intellectual or theoretical understanding ability to carry out intentional motor acts and is commonly assessed by giving the patient a common object such as a hairbrush or pencil and asking the patient to show how it is used. A patient unable to carry out such motor acts is referred to as having apraxia draw a clock tests what? - Correct Answer-executive functioning gnosia - Correct Answer-ability to name objects showing a patient a common object such as a pen, watch, or stethoscope and asking whether he or she can identify it and describe how it is used who should get post exposure ppx with MMR vaccine? - Correct Answer-First: to be effective, must be given w/in 72 hours Infants <12 months of age are considered to be at high risk for complications from measles and should receive postexposure MMR vaccine, although intramuscular immunoglobulin is also an option. Children who are otherwise fully vaccinated do not need additional prophylaxis. Pregnant women cannot receive the MMR vaccine due to fetal risk, but they should receive intravenous immunoglobulin if they do not have evidence of immunity. Health care workers only need to be given the MMR vaccine as prophylaxis if they did not receive two doses previously. HCTZ electrolyte abnormalities - Correct Answer-Remember HYPER-GLUC!!! Hyper (increased) Glucose, Low BP (Orthostatic hypotension, also remember Low Sodium) Uric acid, Calcium risk of what dental problems increase in pregnancy? - Correct Answer-risk of dental caries, loose teeth, gingivitis, and periodontitis all increase during pregnancy oral cavity exposed to more gastric acid due to vomiting and morning sickness --> cavities decreased immune system to fluctations in E/P -> gigivitis and periodonitis decreased strength of tendons --> loose teeth USPSTF fluoride supplementation recommendations - Correct Answer-start at age 6 mo if primary water supply is fluoride deficient test well water to see if fluoride Treatment of rheumatic fever - Correct Answer-PEPP: - Prevention of permanent cardiac damage - Elimination of strep - Palliation of other symptoms - Prevention of recurrence Antibiotics Aspirin/NSAIDS: watch for Reye syndrome Bed rest in the acute febrile stage Prophylactic Penicillin G given IM q month plus 2 oral doses of Penicillin or a Sulfa until the are at least 20 years old or they have had 5 years of treatment. takasubo cardiomyopathy management - Correct Answer-The clinical presentation and laboratory studies can mirror acute coronary syndrome and should be treated similarly. Once symptoms and cardiac abnormalities resolve, treatment is no longer indicated and may be withdrawn if there are no signs of coronary disease. Because this patient currently has cardiomyopathic abnormalities, a diuretic, ACE inhibitor, and -blocker are indicated. Ambulatory cardiac monitors are not indicated for this patient with a known diagnosis of Takotsubo cardiomyopathy. A pacemaker is not indicated in the absence of arrhythmias caused by conduction abnormalities. All printed patient education material should be on what education level? - Correct Answer-5th to 6th grade level according to AAP when do you check child's hgb lvls for anemia? - Correct Answer-12 months of age rubber band ligation used for what? - Correct Answer-Grade I - III internal hemorrhoids NOT EXTERNAL! How do you treat thrombosed external hemorrhoid - Correct Answer-excision first-line treatment for hemorrhoids with increased fiber intake.. Office-based surgical excision of the thrombosed external hemorrhoid within 2-3 days of symptom onset may provide significant symptomatic relief (SOR B) and result in a lower risk of recurrence. While conservative treatment with topical therapies such as corticosteroids may be helpful, symptomatic relief is prolonged with excision of the thrombosed hemorrhoid.