ABFM ITE EXAM 1254 Questions With 100% Correct Answers Latest Update 2024 ALREADY GRADED A, Exams of Community Corrections

Download ABFM ITE EXAM 1254 Questions With 100% Correct Answers Latest Update 2024 ALREADY GRADED A and more Exams Community Corrections in PDF only on Docsity! ABFM ITE EXAM 1254 Questions With 100% Correct Answers Latest Update 2024 ALREADY GRADED A+ CAP antibiotic that causes VF ANSWER: Azithromycin - The arrhythmia results from prolongation of the QT interval and is also more common in patients with a prior cardiac history. Anti-DM medications for weight loss ANSWER: GLP1 receptor agonists e.g. Exenatide SGLT-2 inhibitor e.g. Canagliflozin Screening test with greatest potential for over diagnosis ANSWER: PSA Clinical manifestation of amyotrophic lateral sclerosis ANSWER: Asymmetric leg weakness Opioid to avoid in palliative patient with severe hepatic dysfunction ANSWER: Methadone - It is metabolized and cleared by the liver, and should therefore not be used in patients with severe hepatic impairment. It is, however, a reasonable option for patients with severe renal impairment. Lung cancer screening with low dose CT Chest annually ANSWER: Adults 55-80yo with 30 pack year history and currently smoking or quit within last 15 years NOAC with reversal agent ANSWER: Dabigatran Reduces alcoholism but creating an acute ethanol sensitivity ANSWER: Disulfiram Antidepressant to be avoided in the elderly ANSWER: U.S. federal labor law requires companies with >50 employees to provide which benefits for employees who are nursing mothers ANSWER: Influenza vaccination in those with potential egg allergy ANSWER: All currently available influenza vaccines, with the exceptions of recombinant and cell-culture-based inactivated influenza vaccines, are prepared using embryonated egg culture and can potentially provoke allergic and anaphylactic reactions. For those who report that they can eat lightly cooked scrambled eggs, vaccination can proceed without precaution or observation. Those who have experienced only hives can also receive any influenza vaccine appropriate for their age and health status. People who have experienced symptoms such as hypotension, wheezing, nausea, or vomiting, or reactions requiring emergency attention or epinephrine after eating eggs or egg-containing foods can also receive any influenza vaccine appropriate for their age and health status and also do not need to be observed. However, the vaccine should be administered by a provider who can recognize and manage severe allergic reactions. How is the Timed Up and Go test useful in GRM patients? ANSWER: Helps to assess the risk of falling Antidepressant that can prolong QT interval to be avoided in those on concomitant atypical antipsychotics ANSWER: Citalopram, Escitalopram Other SSRIs, as well as bupropion, venlafaxine, and mirtazapine, do not have this effect. Both tricyclic antidepressants and antipsychotics, commonly used in patients also taking SSRIs, can cause QT prolongation, making their combined use problematic. Antibiotic for traveller's diarrhoea ANSWER: Azithromycin Prevented by washing hands frequently Most effective medication for treating fibromyalgia ANSWER: TCAs > SSRIs (helps with some pain reduction) In a healthy full-term infant who is exclusively breastfed, iron supplementation should begin at what age in order to prevent iron deficiency anaemia? ANSWER: 4 months - In preterm babies (before 37w), elemental iron supplementation (2mg/kg per day) should begin at 1 month of age and should continue until 12 months of age, unless the infant had multiple blood transfusions. In primary nephrotic syndrome, other than proteinuria and low albumin, what else is commonly observed? ANSWER: Coagulopathy Chronic medication that can cause B12 deficiency ANSWER: Metformin Strongest risk factor for primary hypertension in children and adolescents ANSWER: Elevated BMI While Staphylococcus aureus and Streptococcus species are the most common causes of skin and soft-tissue infection, which organism should also be considered? ANSWER: Pseudomonas Treatment of erythrasma (Wood's lamp coral pink/red fluorescence, fine-scaled with a cigarette- paper appearance) caused by Corynebacterium minutissimum infection Medications that can reduce serum Vitamin D levels Rifampicin, Phenytoin Isolated posterior cruciate ligament tear Direct blow to the anterior tibia whilst knee is in flexion What should patients be periodically monitored for whilst on Amiodarone? TSH Drug of choice in depressed persons with cardiovascular disease SSRIs Antibiotics causing prolonged QT Macrolides Benign nocturnal limb pains of childhood (previously known as "growing pains") Usually occur in the evening or night time, may sometimes wake patient from sleep, short-lived (about 30min), not associated with redness/swelling/tenderness/limping. ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: No further work-up necessary. Treatment of OSA in children Adenotonsillectomy What is most likely seen with diastolic dysfunction? A preserved ejection fraction Positive hip FADIR and FABER testing Hip labral tear Childhood vaccination carrying risk of febrile seizure in up to 2 weeks post-administration MMR Elbow Moving Valgus Stress Test Ulnar collateral ligament injury In United Stated, at what age is it recommended for cow's milk be introduced? 12 months ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: Treatment for lateral dislocation of the patella ANSWER: Medically directed pressure on the patella while extending the leg Treatment of SSRI overdose ANSWER: Finkelstein's test ANSWER: For detecting De Quervain's Tenosynovitis, where thumb is in the fist and you ulnarly deviate looking for pain in the radial wrist. Indication for 2nd dose of pneumococcal polysaccharide vaccine in children ANSWER: Sickle Cell Disease Excessive femoral anteversion with normal mobility ANSWER: Observation Surgery should be reserved for children 8-10 years of age who still have cosmetically unacceptable, dysfunctional gaits. Most effective treatment for OCD What should be monitored whilst on testosterone replacement therapy? ANSWER: Haematocrit (may increase) - Polycythaemia is thus an absolute contraindication to starting testosterone Treatment of narcolepsy ANSWER: Treatment involves improving both the quantity and quality of sleep during the night, which can be accomplished with sodium oxybate. This improves daytime alertness and cataplexy. Scheduling naps is the second important aspect of managing narcolepsy. The third important step is the use of stimulants such as methylphenidate to improve function during the day. Periodic daytime naps may also help to reduce symptoms. Initial screening for Hereditary Haemochromatosis in those with persistent abnormal LFTs i.e. raised transaminases ANSWER: Fe and transferrin saturation Most common cause of chest pain in children ANSWER: Musculoskeletal When should patient with hyperplastic polyps on colonoscopy be due for repeat surveillance? ANSWER: Small (less than 10 mm) hyperplastic polyps in the rectum and sigmoid rarely exhibit dysplasia or develop into colon cancer, colonoscopy may be repeated in 10 years if they are the only finding. Elevated serum levels of this is indicative of Vitamin B12 deficiency ANSWER: Mmethylmalonic acid Most common cause of child abuse in USA ANSWER: Neglect Most common cancer diagnosed in the USA ANSWER: Basal cell carcinomas Which parasitic infection (in the USA) when left neglected has potential consequences that include cardiomyopathy, heart failure, and fatal cardiac arrhythmias? ANSWER: American trypanosomiasis (Chagas disease) A U.S. Preventive Services Task Force "D" recommendation indicates ANSWER: Moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits According to DSM-5, what is the severity of anorexia nervosa based on? ANSWER: BMI Which agent used to reduce PPH secondary to stony should be avoided in asthmatics? ANSWER: Carboprost (as it causes bronchospasms) What is a vector for Bartonella quintana, which causes trench fever, an influenza-like syndrome with relapsing fever, especially seen in homeless people? ANSWER: Lice Treatment of acute otitis media in children ANSWER: High dose Amoxicillin 80-90mg/kg for 10 days, antibiotic therapy can be deferred in children two years or older with mild symptoms and can be followed-up in 3 months. Treatment of childhood constipation (usually functional) ANSWER: PEG preferred more than Lactulose as less side effects and increased effectiveness Prophylactic TB treatment ANSWER: Isoniazid for 9m allowed as tolerated. Treatment should be continued until symptoms abate—usually within three to six weeks. Treatment of depression associated with erectile dysfunction ANSWER: Bupropion or Mirtazapine Treatment of menopausal symptoms ANSWER: Black cohosh Diagnostic criteria for PCOS ANSWER: NEED 2 OF 3 - Oligo or anovulation - Clinical/biochem signs of hyperandrogenism - Sonographic evidence of polycytic ovary Indication for carotid endarterectomy ANSWER: >70% stenosis of carotid vessels for symptomatic patient Ringed appearance of oesophagus ANSWER: Is indicative of eosinophilic oesophagitis to treat with PPIs Medication that increases risk of osteoporosis ANSWER: Ranitidine, Thiazolidinediones (glitazones) Greatest modifiable risk factor of AAA ANSWER: Cigarette smoking Immunotherapy can prevent recurrence of severe allergic reactions triggered by ANSWER: Wasp (insect) stings Infant factor to look out for in potential breastfeeding issues ANSWER: Dimpled cheeks, chin not pressed against breast, chalky stools Which disorder of sexual development is associated with an increased risk of endometrial cancer, coeliac disease, and structural heart defects? ANSWER: Turner's syndrome - Karyotyping Treatment of life-threatening heat stroke ANSWER: Aggressive ice water immersion Colonoscopy after 75 years old ANSWER: The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history. Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy. Peripheral blood film character in B12 deficiency ANSWER: Hypersegmented polymorphonuclear WBCs Biopsy proven coeliac disease monitoring after being on gluten-free diet ANSWER: IgA Tissue Transglutaminase antibody Hypokalaemia in DKA due to insulin causing K being pushed into cells ANSWER: Potassium replacement Buprenorphine therapy should be initiated when patient is in mild to moderate withdrawal from opioids ANSWER: Occurs 48-72h after first administration, part of antibiotic stewardship programme to ensure judicious use. Prehn's sign ANSWER: Physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion. Treatment of epididymitis ANSWER: Bed rest, antibiotics (Levofloxacin), scrotal support, and ice compresses. A healthy 2-month-old female is brought to your office for a routine well baby examination by both of her parents, who have no concerns. The parents refuse routine recommended vaccines for their daughter because of their personal beliefs. You want to incorporate patient- centeredness and are also concerned about improving the health of the population. You decide to follow the CDC recommendations by? ANSWER: Having the parents sign a refusal to vaccinate form. Prepatellar bursitis is a common superficial bursitis caused by microtrauma from repeated kneeling and crawling. Other terms for this include housemaid's knee, coal miner's knee, and carpet layer's knee. It is usually associated with minimal to no pain. ANSWER: The proper management of prepatellar bursitis is conservative and includes ice, compression wraps, padding, elevation, analgesics, and modification of activity. There is little evidence that a corticosteroid injection is beneficial, even though it is often done. If inflammatory bursitis is suspected, a corticosteroid injection may be helpful. Fluid aspiration is indicated if septic bursitis is suspected. Surgery can be considered for significant enlargement of a bursa if it interferes with function. Absolute contraindication to fibrinolytic therapy ANSWER: A history of an ischemic stroke within the past 3 months unless the stroke is diagnosed within 4½ hours. Treatment of sudden SNHL likely idiopathic ANSWER: Oral Prednisolone (recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10-14 days) Ottawa Ankle rules: negative i.e. ankle sprain ANSWER: Compression combined with lace-up ankle support or an air cast, along with cryotherapy, is recommended and can increase mobility. Early mobilization, including weight bearing as tolerated for daily activities, is associated with better long-term outcomes than prolonged rest. Risk factor for atrial fibrillation ANSWER: Alcohol use Assessing response to oral iron therapy in iron deficiency anaemia Reticulocyte count Use of IV contrast in those with shellfish allergies No correlation Shoulder pain with weak internal rotation Subscapularis Shoulder pain with weak external rotation Infraspinatus, teres minor Shoulder pain with weak abduction Supraspinatus, deltoid First line imaging modality for acute abdominal pain in children Ultrasonography First line anti-hypertensives in African-Caribbean patients Calcium-channel blockers, Thiazides (e.g. Chlorthalidone) ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: Both typical and atypical antipsychotics increase the risk of mortality in patients with dementia. The typical antipsychotics are more commonly associated with extrapyramidal side effects. Diabetes mellitus and agranulocytosis are associated with the atypical antipsychotics, including Risperidone. Periodic monitoring of serum glucose levels and CBCs is recommended. For patients who have been taking antipsychotics for >/= 3 months and whose symptoms have stabilized, or for patients who have not responded to an adequate trial of an antipsychotic, it is recommended that the drug be tapered slowly with goal of stopping. Secondary prevention of coronary heart disease ANSWER: Patients <75 years of age with established coronary artery disease should be on high-intensity statin regimens if tolerated. These regimens include Atorvastatin, 40-80 mg/day, and Rosuvastatin, 20-40 mg/day. Moderate-intensity regimens include Simvastatin, 40 mg/day. Subclinical hyperthyroidism patients are at higher risk for several health conditions, including atrial fibrillation, heart failure, and osteoporosis. ANSWER: The American Thyroid Association recommends treating patients with complications who are either over age 65 or have a TSH level <0.1 U/mL. BPPV characteristics ANSWER: Rotational vertigo with test-related head movements, latency period 5-20s sometimes up to 60s, associated with torsional upbeating nystagmus. Preferred antidepressant in elderly ANSWER: Escitalopram. Amitriptyline, Imipramine, and paroxetine are highly anticholinergic and sedating, and according to the Beers Criteria, they can cause orthostatic hypotension. COPD screening with spirometry ANSWER: All patients with a smoking history and symptoms of COPD such as a chronic cough with sputum production and/or chronic and progressive dyspnea. No screening if asymptomatic despite smoking history. The dietary herbal supplement with the highest risk for drug interactions is ANSWER: St John's wort Splint for distal radial fracture ANSWER: Sugar tong Worrisome characteristics of palpitations ANSWER: Patients with a history of cardiovascular disease, palpitations that affect their sleep, or palpitations that occur at work have an increased risk of an underlying cardiac cause. HPV screening in women 21-29yo ANSWER: Current recommendations are for a Pap test with cytology every 3 years for women age 21-29 years with normal results, and the frequency does not change with an increased number of normal screens. Annual HPV screening in patients age 21-29 years has very little effect on cancer prevention and leads to an increase in procedures and treatments without significant benefit. Patient who has had a sleeve gastrectomy should avoid ANSWER: NSAIDs as it is thought to increase the risk of anastomotic ulcerations or perforations Confirming proteinuria in those with positive dipstick protein or with symptoms of nephrotic syndrome ANSWER: Spot urine PCR The only evidence-based treatment that confers significant benefits to children with autism is Desiring pregnancy: Letrozole > Clomiphene Initial evaluation of hypogonadism ANSWER: FSH and LH Internal tibial torsion ANSWER: Usually resolves by 5yo, surgery may be considered in patients older than 8yo who have a severe residual deformity, especially if it is symptomatic or cosmetically unacceptable. Yersinia pestis is an aerobic fermentative gram-negative rod. It causes a zoonotic infection with humans as the accidental host. The disease is spread by a bite from a flea vector, direct contact with infected tissue, or inhalation of infectious aerosols from a person with pulmonary plague. ANSWER: Plague occurs in two regions in the western United States. One region includes northern New Mexico, northern Arizona, and southern Colorado, and the other region includes California, southern Oregon, and far western Nevada. Greatest risk factor for developing osteoarthritis in older adults ANSWER: Obesity Preferred initial evaluation of acute mesenteric ischaemia CT Angiography Contraindication of oestrogen-containing contraception methods Smokers >35 years of age and in patients with migraine with aura. Highest cure rate of basal cell carcinoma Mohs surgery Pharmacotherapy to reduce alcohol consumption and increase abstinence Acamprosate Valvular heart disease in Marfan's syndrome Aortic insufficiency/regurgitation in 80-100%, increases with age and is progressive. May also be associated with mitral valve prolapse. Haemoptysis work-up CXR normally but CT Chest if high risk for malignancy (age, smoking history) ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: ANSWER: If findings are normal, patient should be observed for 2-6 weeks. If there is a recurrence of haemoptysis further evaluation is indicated, which should include an interval history, a repeat examination, and CT Chest. Severe symptomatic aortic stenosis requires surgical intervention i.e. valve replacement ANSWER: Pressure mean gradient >40 mmHg, aortic valve area <1 cm2 and peak aortic jet velocity >4.0 m/s - ACE inhibitors may improve symptoms in patients with aortic stenosis who are not surgical candidates. Rome IV criteria for IBS ANSWER: Recurrent abdominal pain associated with two or more additional symptoms at least 1 day per week in the last 3 months. These symptoms include pain related to defaecation, a change in stool frequency, or a change in stool form. Screening for GDM in pregnancy ANSWER: From 24w Proximal fifth metatarsal stress fracture (Jones fracture) management ANSWER: The diagnosis can be made from his history and the physical examination, with no additional workup. Conservative Rx recommended as initial treatment (ice, compression dressings, and avoidance of activities that aggravate the problem), aspiration for symptomatic relief if there is significant enlargement or symptoms, or for diagnosis and culture if septic bursitis is suspected. The bursa may be injected with a corticosteroid, but this could cause skin atrophy or infection. Surgical bursectomy can be offered for refractory cases lasting over 3 months. Treatment of DVT/PE in pregnancy, cancer-associated thrombosis ANSWER: SC LMWH e.g. Dalteparin, Enoxaparin Medications to decrease mortality in patients with symptomatic heart failure ANSWER: Aldosterone antagonists, beta-blockers Anticoagulation in those with malignancy ANSWER: SC LMWH preferred (NOACs not studied in area of malignancy yet) Mental health screening for refugees ANSWER: Depression, anxiety, and post-traumatic stress disorder AST:ALT ratio for alcoholic liver disease ANSWER: 3:1 Perioperative management of chronic anticoagulation therapy ANSWER: For low-risk patients, it is recommended that Warfarin be discontinued 5 days prior to surgery and restarted 12-24 hours postoperatively. Treatment for Henoch-Schonlein purpura ANSWER: Supportive - Analgesics - Adequate hydration Steroids - For GI inflammation - Relieves pain Seek care if - Stomach pain is sudden or severe - Blood in stool - Vomiting with inability to keep fluids down - Puffy face, hands or feet (sign of renal malfunction) Hypoxaemia following acute illness ANSWER: Prescriptions for supplemental home oxygen should not be renewed for patients who have recently been hospitalized for acute illnesses without assessing them for ongoing hypoxaemia. No apparent benefit derived from supplemental oxygen once their oxygen saturation is 88% or greater on room air. Leser-Trelat sign ANSWER: Abrupt onset of multiple seborrheic keratoses, which is an unusual finding that often indicates an underlying malignancy, most commonly an adenocarcinoma of the stomach. Rocky Mountain Spotted Fever ANSWER: Caused by Rickettsia rickettsii, spread by ticks - Sx: petechial rash on palms and soles (migrating to wrists, ankles, then trunk), headache, fever. Endemic to East Coast (in spite of its name). - Rx: Doxycycline History of pancreatitis in patients with diabetes ANSWER: Amitriptyline may reduce headache duration and severity Painful diabetic peripheral neuropathy ANSWER: Pregabalin In sepsis, a serum lactate value >36 g/dL (4 mmol/L) is correlated with increased severity of illness and poorer outcomes even if hypotension is not yet present. ANSWER: Patients should receive isotonic intravenous fluids such as normal saline or lactated Hartmann's solution at an initial rate of 30 mL/kg in the first 3 hours using small boluses of approximately 500 mL. MRI Breasts ANSWER: Reserved for women at very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history. To reduce dosing error in children, apart from appropriate education to parents ANSWER: Oral syringe should be provided In treatment of Bipolar Disorder, treatment with SSRI as monotherapy should be avoided ANSWER: A combination of antidepressants such as an SSRI, plus a mood stabilizer, which includes anticonvulsants (Lamotrigine, Divalproex), atypical antipsychotics (Quetiapine) - as typical antipsychotics increases risk of QT prolongation, or Lithium, but this is considered second-line therapy. Long-term maintenance therapy with a mood stabilizer is recommended in patients with bipolar I disorder due to the high risk of recurrent mania. NOT Haloperidol. Leading cause of cancer death in men in the United States ANSWER: Lung cancer A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help increase the rates of abstinence and decrease stress-related opioid cravings ANSWER: Clonidine (0.1-0.3 mg every 6-8 hours) The presence of RBC casts on microscopic examination of a spun urine sediment is pathognomonic for ANSWER: Acute glomerulonephritis Mallet finger ANSWER: The inability to actively extend the DIP joint is a hallmark. The inability to passively extend the DIP joint completely may be an indication of trapped soft tissue or bone that may require surgery. Up to one-third of distal extensor tendon injuries are associated with an avulsion fracture, and if the avulsion is greater than 30% of the joint space, referral to an orthopaedic is recommended. Otherwise, immobilization of the DIP joint in extension for 6-8 weeks. Pneumococcal vaccination ANSWER: Both PCV13 and PPSV23 are recommended for patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent persons younger than 65 include chronic lung disease, diabetes mellitus, chronic heart disease, smoking, and alcoholism. Treatment of acute Bell's palsy ANSWER: Antiviral medication along with corticosteroids is significantly more effective than corticosteroids alone. The medications are most effective if started within 72 hours of symptom onset. Test to confirm diagnosis of Cushing's ANSWER: 24h urinary free cortisol Obesity hypoventilation syndrome (carbon dioxide retention - PaCO2 >45 mm Hg, in an individual with a BMI > 30 kg/m2) - Eat three meals and one or two snacks daily. Very dry foods, bread, and fibrous vegetables are most likely to cause problems. - Fluids should be avoided during meals and for 15-30 minutes before and after meals. - Those desiring pregnancy should wait 12-18 months after surgery. - BMD be done every 2 years. Acute bronchitis in adults is usually viral ANSWER: Indications for a chest radiograph include: bloody sputum, rusty-colored sputum, or dyspnoea; a pulse rate >100 beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest radiograph is also indicated if there are abnormal findings on a chest examination such as fremitus, egophony, or focal consolidation. Infective endocarditis prophylaxis with Amoxicillin 2g - Clindamycin or azithromycin can be used in patients with a penicillin allergy. If the penicillin allergy is not associated with anaphylaxis, angioedema, or urticaria, then cephalexin would be an appropriate antibiotic choice. ANSWER: Currently antibiotics are indicated for prosthetic cardiac valves, previous infective endocarditis, unrepaired cyanotic congenital heart disease or a repaired congenital defect with a residual shunt, and a cardiac transplant with valve regurgitation due to a structurally abnormal valve. Septic arthritis ANSWER: Diagnostic test of choice is analysis of synovial fluid obtained through arthrocentesis. Most appropriate psychotherapy for patients with obsessive-compulsive disorder ANSWER: CBT Molluscum contagiosum is a common disease during childhood, but can also occur in adolescents and adults. It is caused by a poxvirus and is characterized by flesh-colored, dome- shaped papules with central umbilication, most commonly on the trunk, axilla, popliteal or antecubital fossae, and crural folds. ANSWER: If lesions are asymptomatic and not inflamed, the initial treatment is observation, with most lesions resolving spontaneously within 2-12 months. If the lesions are inflamed or pruritic, then topical corticosteroid treatment, chemical treatment with cantharidin, podofilox 0.5% solution, curettage, or cryotherapy may be indicated. - Best management in a patient who is bothered by it is to induce resolution. Treating acute rhinosinusitis ANSWER: In the first 3-4 days, viral and bacterial rhinosinusitis are indistinguishable. Antibiotics should not be routinely prescribed for acute mild to moderate sinusitis unless symptoms persist for 7 days or worsen after initial improvement. Watchful waiting without antibiotic treatment (supportive Rx with intranasal corticosteroids, nasal saline irrigation) is appropriate when follow-up is accessible. - Amoxicillin with or without clavulanate, cephalosporins if allergic to penicillin At what age should a patient at average risk be switched from a universal screening strategy for colon cancer to a more individualized strategy? ANSWER: 75yo (stop after 85yo) Classic early finding of muscular dystrophies ANSWER: Head lag when sitting up Most commonly associated with oligohydramnios ANSWER: Posterior urethral valves Amniotic fluid volume is regulated in part by fetal swallowing, inspiration, and urination. Some malformations of the urinary tract, including renal agenesis and persistent obstruction from posterior urethral valves, lead to oliguria or anuria, and are associated with marked oligohydramnios. Treatment of cellulitis Oxygen saturation of 90% or more on room air is sufficient for infants with bronchiolitis, and using supplemental oxygen to maintain higher oxygen saturations only prolongs hospitalization because of an assumed need for oxygen. Scoliosis ANSWER: There are three major risk factors for curve progression of idiopathic scoliosis: the magnitude of the curve at presentation, the potential for future growth, and female sex. Of these factors, curve progression has the most impact on the need for referral versus observation. The Cobb angle is based on spine radiology that quantifies the magnitude of the scoliosis curve. If the Cobb angle is >/= 20° there is a high risk that the curve will progress and that the patient may need treatment. Treatment for osteopaenia is indicated when the 10-year risk of a major fracture reaches ANSWER: 20% Hyperthyroid treatment in pregnancy ANSWER: Since methimazole is associated with birth defects when used in the first trimester, propylthiouracil is preferred. Methimazole should be considered after the first trimester because the risk of congenital anomalies is less than the risk of liver failure associated with propylthiouracil. A 30-year-old male is treated with topical medications for his papulopustular rosacea with only partial improvement. The preferred antibiotic is ANSWER: Doxycycline Pre-op evaluation ANSWER: A healthy patient would be classified as ASA I, while a patient with mild systemic disease would be classified as ASA II. All patients who are having major surgery should be offered preoperative laboratory testing, including a CBC and renal function testing. For patients who are ASA III or IV and have chronic liver disease or take anticoagulants, coagulation testing should be considered. There is no compelling evidence to support either a chest radiograph or an EKG as part of a routine preoperative evaluation. Most common hip disorder in adolescents (ages 8-15) ANSWER: SUFE should be suspected in an adolescent who has unexplained pain in the hip, groin, thigh, or knee. It is rarely associated with trauma, overuse, or prior illness. On examination the most indicative sign is limited internal rotation of the involved hip. Bilateral radiographs of the hips, including frog-leg lateral views, should be obtained. Legg-Calve-Perthes disease (insidious) and transient synovitis (acute onset with fever) are more common in children under age 10. COPD GOLD ANSWER: A risk category of A (low risk, fewer symptoms) requires either a SAMA/SABA as the initial pharmacologic management. LABA/LAMA are indicated for patients with a GOLD combined assessment category of B or worse. Long-acting inhaled corticosteroids are indicated for patients with a GOLD combined assessment category of C or worse. ACEi and ARB as anti-hypertensives with renoprotective effects ANSWER: May tolerate a rise of <30% in serum creatinine after initiation. Rises in serum creatinine of >30% from baseline increase the risk of renal failure, adverse cardiac outcomes, and death. Metatarsal stress fractures (common second and third) ANSWER: No weight bearing for a few days, possibly using a posterior splint, transitioning to a walking boot or short leg cast, and then a rigid-soled shoe in 4-6 weeks. ANSWER: Ascaris lumbricoides is a large roundworm that typically infects the ileum. Symptoms are variable but large infections can lead to intestinal obstruction. Pinworms are much smaller and typically present with anal pruritus. Tapeworms can be large, but are flat and segmental in appearance, and are typically found in the stool as segments called proglottids. Hookworms are also round, but are typically 6-12 mm in length. They are a significant cause of anemia in children globally. Precocious puberty in boys ANSWER: Penile enlargement before 9yo Isolated sparse pubic and axillary hair growth and axillary odour is referred to as premature adrenarche, and represents high levels of dehydroepiandrosterone rather than activation of the hypothalamic-pituitary-gonadal axis that leads to puberty. Incidental isolated leukocytosis ANSWER: For most cases without a clear cause, a repeat CBC with differential and a peripheral smear review are indicated to confirm leukocytosis, determine subtypes, and look for concerning abnormalities on the smear. The drug class of choice for the management of breathlessness in end-of-life care is ANSWER: Opiates When administered at appropriate doses, opiates do not reduce or compromise respiratory status and do not hasten dying. Opiates help to reduce the sense of air hunger in patients with dyspnea. Avoid Donepezil (used in Alzheimer's, cholinesterase inhibitor) in those with syncope ANSWER: Due to increased risk of bradycardia (+ prolonged PR) Hypertension in paediatric population ANSWER: All paediatric patients with confirmed hypertension should have further evaluation to check for renal dysfunction as well as other cardiac risk factors. Additionally, renal ultrasonography is recommended to evaluate for renal disease and echocardiography to evaluate for end-organ damage that would affect treatment goals. Additional studies, such as plasma renin and catecholamine levels or renovascular imaging, may be indicated in children with abnormalities on initial evaluation that suggest secondary causes of hypertension. Patients on valproate who present with altered mental status or encephalopathy ANSWER: Hyperammonaemia Somatic symptom disorder ANSWER: Characterized by multiple unexplained physical symptoms, insistence on surgical procedures, and an imprecise or inaccurate medical history. SSRIs and tricyclic antidepressants (esp. Amitriptyline) have been found to be the most effective pharmacotherapy. What is the most accurate and appropriate manoeuvre to detect an anterior cruciate ligament tear? ANSWER: Lachman test De Quervain's tenosynovitis usually occurs with repeated use of the thumb and is characterized by pain in the radial wrist. The course is typically self-limited but can last for up to a year, so waiting would not be a good option. ANSWER: Immobilization in a thumb spica splint and an NSAID for 1-4 weeks. Vancomycin would be indicated if the patient had a history of illicit drug use, purulent drainage, concurrent evidence of MRSA infection elsewhere, nasal colonization with MRSA, or severe cellulitis. Febrile illness in children ANSWER: Any infant younger than 29 days, and any infant or child with a toxic appearance regardless of age, should undergo a complete sepsis workup and be admitted for observation until culture results are obtained or the source of the fever is found and treated. Nontoxic-appearing febrile infants 29-90 days of age who have a negative screening laboratory workup, including a CBC with differential and a normal urinalysis, can be sent home and followed up in 24 hours. Observation with no follow-up is an appropriate strategy in nontoxic children, but only if the child is 3-36 months of age and the temperature is under 39.0°C (102.2°F). Nontoxic children 3-36 months of age should be reevaluated in 24-48 hours if their temperature is >/= 39.0°C. Fragile X syndrome ANSWER: Prepubescent males are recognized by large ears, an elongated face, macrocephaly, or frontal bossing. After puberty, a prominent jaw and macro-orchidism is characteristic. Normal pulmonary artery pressure ANSWER: 10-14 mmHg, pulm HTN >25 mmHg or > 35 mmg Hg during exercise - Right heart catheterization is not recommended for pulmonary hypertension due to left heart disease because vasodilators are not a treatment option. Sever's Disease (Calcaneal Apophysitis) ANSWER: Inflammation of the calcaneal growth plate that occurs during adolescence. Rapid growth increases tension in the achilles tendon, which places a shearing force on the growth plate. Heel pain is aggravated by activities such as running & jumping. 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. Ottawa Ankle rules: positive ANSWER: Ankle radiography should be performed when a patient presents with pain in the malleolar region and has either point tenderness over the tip of the malleolus or the posterior edge of the affected bone (distal 6 cm), or is unable to bear weight at the time of injury and while being evaluated in the emergency department or office. Inability to bear weight is defined as the inability to take 4 steps. A limp when weight is transferred to the affected extremity still counts as being able to bear weight. Treating pre-eclampsia ANSWER: Delivery is the definitive treatment for preeclampsia. The timing of delivery is determined by the gestational age of the foetus and the severity of preeclampsia in the mother. Vaginal delivery is preferred over cesarean delivery. In addition to behavioral counselling, which intervention is associated with the most successful outcome in smoking cessation? ANSWER: Varenicline (Champix) is an FDA-approved pharmacotherapy that is an effective option for smoking cessation with or without behavioural therapy. - Alleviate symptoms of craving and withdrawal, while simultaneously resulting in a reduction of the rewarding and reinforcing effects of smoking. Both Bupropion and Nortriptyline have been found to increase smoking cessation success rates too. Most effective medication for motion sickness ANSWER: Transdermal scopolamine is more effective than oral scopolamine Sleep hygiene for insomnia ANSWER: Interferes: pets in the bedroom, caffeine consumption after 4 p.m., exercising within 2 hours of bedtime, and nicotine use. Facilitate: maintaining an environment conducive to sleep, including a cool room and a comfortable bed, limiting use of the bedroom to sleep and sex and delaying going to bed until sleepy. Treatment of diarrhoea-predominant IBS ANSWER: SSRIs, TCAs Treating Generalised Anxiety Disorder ANSWER: SSRIs are 1st line though Bupropion is only approved for treating depression. CBT and exercise can also improve symptoms. - Avoid Benzos due to addicting effect - Quetiapine 2nd line Health screening types ANSWER: Primary prevention targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition. Examples include childhood vaccination programs, water fluoridation, antismoking programs, and education about safe sex. Secondary prevention targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications. Examples include routine Papanicolaou tests and screening for hypertension, diabetes mellitus, or hyperlipidemia. Tertiary prevention targets individuals with a known disease, with the goal of limiting or preventing future complications. Examples include screening patients with diabetes for microalbuminuria, rigorous treatment of diabetes mellitus, and post-myocardial infarction prophylaxis with beta-blockers and aspirin. Toe fractures ANSWER: Nondisplaced lesser toe fractures are generally treated with a rigid-sole shoe or buddy taping to an adjacent toe. The great toe has an increased role in weight bearing and balance, and fractures of this toe have a greater potential morbidity. Because of this, these fractures are generally treated with a short leg walking cast with a toe plate. Those with intra-articular involvement should get a repeat radiograph after 1 week. Intra- articular fractures with 25% or greater involvement of the joint surface should be referred for surgical treatment. Patients on Hydrochlorothiazide may develop hyponatraemia whilst on? ANSWER: Carbamazepine due to SIADH Age-related macular degeneration (Amsler grid testing notes distorted grid lines) ANSWER: Smoking is a modifiable risk factor and smokers should be counselled to quit. Not reversible but treatment can delay progression or stabilize the changes. Nutrition route for severe acute pancreatitis ANSWER: Continuous enteral feeding (esp. in first 48h) - Help prevent infectious complications, such as infected necrosis, by maintaining the gut mucosal barrier and preventing translocation of bacteria that may seed pancreatic necrosis. Bedbug bites ANSWER: Having multiple exposures on skin often not covered by clothing would be typical of household fleas or bedbugs. The American Academy of Paediatrics recommends screening children 9-11yo for ANSWER: Dyslipidaemia If patient deemed at high risk of iron deficiency anaemia, universal screening should be conducted at ANSWER: 12 months of age and again at 15-30 months of age At what age is HIV screening recommended in adolescents ANSWER: 16-18 years of age Cervical cancer screening in women 21-65yo ANSWER: The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting). Initial management of stable, regular, monomorphic wide-complex tachycardia ANSWER: Adenosine Screening for hepatitis C virus (HCV) with an anti-HCV antibody test is recommended for all adults at high risk of infection, and one-time screening is recommended in adults born between 1945 and 1965. ANSWER: If the anti-HCV antibody test result is positive, current infection should be confirmed with a qualitative HCV RNA test. Diagnosing ADHD in adults ANSWER: Requires symptoms that interfere with social, academic, or occupational functioning and are present in more than one setting. DSM-5 states that a history of symptoms before age 12 is required for the diagnosis. Calcium levels in Di George syndrome ANSWER: Low (hypocalcaemia) GORD in infants ANSWER: Features of gastroesophageal reflux include a history of recurrent pneumonia, a low growth curve, a family history of sudden infant death syndrome, and normocytic anaemia. Which treatments for cough has evidence of efficacy and safety when used for children from 1 to 2 years of age? ANSWER: Honey Acute chest syndrome in Sickle Cell Disease ANSWER: Atypical pathogens predominates (Mycoplasma and Chlamydophila). Viral infections are also common, especially in children with ACS. Other possible pathogens include Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Therefore, the use of a third-generation cephalosporin along with azithromycin is the recommended antibiotic coverage. Also include supportive care with supplemental oxygen, intravenous fluids, pain control, and incentive spirometry. Absorption of levothyroxine is impaired by several gastrointestinal conditions ANSWER: Includes atrophic gastritis, chronic PPI use, and Helicobacter pylori infection. Acute uncomplicated cystitis antibiotic choice ANSWER: Bactrim/Co-trimoxazole, Nitrofurantoin, Fosfomycin 1. Angry/irritable mood (often loses temper, is often touchy or easily annoyed, is often angry and resentful) 2. Argumentative/defiant behaviour (often argues with authority figures or with adults, often actively defies or refuses to comply with requests from authority figures, often deliberately annoys others, often blames others for his/her mistakes or misbehaviour) 3. Vindictiveness (has been spiteful or vindictive at least twice within the past 6 months) These behaviors must be directed toward at least one person other than a sibling. Functional dyspepsia has 2 subtypes i.e. epigastric pain syndrome and postprandial distress syndrome ANSWER: Patients with epigastric pain syndrome are more likely to respond to proton pump inhibitors or H2-blockers. Patients with predominantly postprandial distress symptoms are more likely to improve with a motility agent such as metoclopramide. Thyroid eye disease in Graves ANSWER: Unlike radioactive iodine, methimazole has been shown to decrease the risk of development or progression of ophthalmopathy in Graves disease. Managing vertebral compression fractures ANSWER: Current evidence supports initial conservative treatment (early mobilisation where tolerated) before considering vertebroplasty or kyphoplasty. In evaluating the usefulness of this test to either support or exclude a diagnosis of endometrial cancer, the most useful statistic is the ANSWER: Likelihood ratio - The likelihood ratio indicates how a positive or negative test correlates with the likelihood of disease. - Other useful statistics include PPV, NPV. Constitutional growth delay, defined as delayed but eventually normal growth in an adolescent, is usually genetic. ANSWER: If evaluation of the short adolescent male reveals no evidence of chronic disease, if his sexual maturity rating is 2 or 3, and if his height is appropriate for his skeletal age he can be told without endocrinologic testing that he will begin to grow taller within a year or so. Child grew up in a household where there was substance abuse, mental illness, and violent treatment of her mother. You are told that the child's father is now incarcerated. Considering how adverse childhood experiences affect behavior and health, this child is at greatest risk for? ANSWER: Alcoholism Pharmacotherapy for urinary stones ANSWER: Alpha1-blockers such as doxazosin, prazosin, and tamsulosin A 48-year-old female is treated appropriately for MRSA bacteremia. An echocardiogram is negative for endocarditis. There are no indwelling devices such as prosthetic heart valves or vascular grafts. ANSWER: Repeat blood cultures 2-4 days after the initial set and as needed thereafter. Contraindication to the use of GLP-1 agonists ANSWER: Patients with medullary thyroid cancer or multiple endocrine neoplasm syndrome, or with a family history of these conditions. Coin rubbing is a traditional healing custom practiced in? ANSWER: Primarily in east Asian countries such as Cambodia, Korea, China, and Vietnam. A pathogen for community-acquired pneumonia in a patient who has a history of a hotel stay or cruise ship travel within the past couple of weeks. ANSWER: Legionella HPV vaccination doses for children ANSWER: In 2016 the CDC changed the recommendation for the number of HPV vaccine doses for children ages 11-14. Children in this age group need only two doses of HPV vaccine 6-12 months apart. However, if they received two doses of HPV vaccine less than 5 months apart, they still need to have the third dose. Children and young adults over the age of 14 and those with certain immunocompromising conditions still require three doses of HPV vaccine. Informed consent to treat is considered an important ethical and legal part of caring for children and adolescents. ANSWER: Children below the age of majority must have proof of permission to treat from a parent or guardian for non-emergent care. This does not apply to emergency situations in which a delay in care could result in serious harm. - Another exception to parental consent is when a child is considered emancipated under state law. This can happen with a court order, or (in some states) if the child is married, is a parent, is in the military, or is living independently. - Either biologic parent can consent to treatment unless one of them is explicitly denied guardianship. - If a child presents with a non-emergent condition and does not have evidence of permission from a parent or guardian, permission should be sought before the physician interaction takes place. Surveillance of pulmonary nodules ANSWER: For a low-risk patient with a nodule 4 mm to <6 mm in size, a repeat noncontrast CT at 12 months is recommended. If it is unchanged, no further follow-up is needed. - Risk factors for lung cancer include a previous malignancy, a positive smoking history, and age >/= 65. Spiritual assessment upon hospital admission to be done by ANSWER: Physician - It is very appropriate for a physician to conduct a spiritual assessment in older, hospitalized patients with critical or terminal illnesses. Uncomplicated impetigo can be treated with topicals ANSWER: Mupirocin (Bactroban) Patellofemoral pain syndrome is one of the most common causes of knee pain in children, particularly adolescent girls. ANSWER: Pain beneath the patella is the most common symptom. Squatting, running, and other vigorous activities exacerbate the pain. Walking up and down stairs is a classic cause of the pain, and pain with sitting for an extended period is also common. The physical examination reveals isolated tenderness with palpation at the medial and lateral aspects of the knee, and the grind/apprehension test is also positive. Most appropriate Rx: reducing running distance, and physical therapy. Cupping on fundoscopy - Patients with ascites should be limited to 2000 mg of sodium daily - Often suffers from malnutrition and hence high-protein diet recommended (also results in improved mental status) Statins can be safely used in patients with cirrhosis. Their cardiovascular benefits are well established and the risk of associated liver failure is extremely low. In a patient with suspected pulmonary embolism, next investigations include ANSWER: - A D-dimer level is the next most appropriate test for this low-probability scenario. - Compression ultrasonography would be the next test for a patient with an intermediate or high pretest probability for DVT. - CT angiography would be the next test for a clinically stable patient with an intermediate or high pretest probability of pulmonary embolism. A VQ scan would be the next test if a CT angiogram were indicated in a patient with a contraindication such as contrast allergy, renal disease, or pregnancy. - Echocardiography would be the next test for a critically ill patient with a high pretest probability of pulmonary embolism. HbA1c goal for diabetics ANSWER: In patients >/= 65 years of age treated with medication for type 2 diabetes mellitus, HbA1c of 7%-8% have shown the greatest reduction in mortality in multiple studies. Radiographic character of small bowel obstruction ANSWER: Central abdomen, minimal or no colonic gas if mechanical, otherwise multiple gas-filled levels with distended bowel resembling inverted U, valvulae conniventes also known as Kerckring folds/valves or plicae circulares. Medications shown to improve mortality in patients with heart failure with a reduced ejection fraction ANSWER: ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, and in African- American patients, direct-acting vasodilators. - Among the beta-blockers, carvedilol, bisoprolol, and metoprolol succinate have this indication. In a patient with sepsis, vasopressors are indicated when fluid resuscitation does not restore organ perfusion and blood pressure. ANSWER: Norepinephrine and dopamine are the preferred pressor agents; however, norepinephrine appears to be more effective and has a lower mortality rate. It is a potent vasoconstrictor and inotropic stimulant and is useful for shock. As a first-line therapy, norepinephrine is associated with fewer adverse events, including arrhythmia, compared to dopamine. Buckle/torus fractures revealed as a bend in the cortex of the distal radius ANSWER: Will heal with almost any choice of treatment. Most clinicians opt for casting to reduce the chance of reinjury during the first few weeks of healing, but parent preference in this regard is important. Long-acting reversible contraception (LARC) includes the copper IUD, levonorgestrel IUDs, and subdermal implants. ANSWER: LARCs can be placed at any point in the patient's menstrual cycle. There should be evidence that the patient is not pregnant prior to placement. Treating Polymyalgia Rheumatica ANSWER: The hallmark of this condition is the rapid and often dramatic response, typically within a few days, to low dose corticosteroids (10-20mg OD). - Usually continued for 1-2 years, with gradual tapering beginning several months after initiation of treatment. A related condition, giant cell arteritis, is associated with transient or even permanent vision loss, typically unilateral but sometimes bilateral. This condition usually presents with headache and tenderness of the affected artery, most commonly the temporal artery. Prompt recognition and the initiation of high-dose corticosteroids are keys to preventing blindness. Ear discharge with grommets in situ ANSWER: Antibiotic eardrops (with or without corticosteroids) can resolve the discharge and improve the illness-related quality of life more quickly than oral antibiotics, corticosteroid eardrops, or saline rinses. The antibiotic eardrops of choice are fluoroquinolones, which are not ototoxic. Which populations should be screened for asymptomatic bacteriuria? ANSWER: Urine culture for pregnant women at 12-16 weeks gestation or at the first prenatal visit if it occurs later Gradually worsening anterolateral hip joint pain that is sharply accentuated when pivoting laterally on the affected hip or moving from a seated to a standing position is consistent with femoroacetabular impingement. ANSWER: The most sensitive finding is reproduction of the pain by the FADIR test. Special radiographic imaging of the flexed and adducted hip can emphasize the anatomic abnormalities associated with impingement that may go unnoticed on standard radiographic series views. Managing asplenic patients ANSWER: IV or IM Ceftriaxone is recommended for patients who have normal laboratory test results and who do not appear ill. 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, they should receive annual influenza immunization. PPSV23 should be given twice, with the second dose given 5 years after the first. Causes of pseudohyponatraemia ANSWER: Hypertriglyceridaemia, hyperalbuminaemia Asthma classification ANSWER: Mild intermittent: symptoms </= 2 days per week, nighttime awakenings </= 2 times per month, an inhaler is required </= 2 days per week, and the FEV1 is >80% of predicted. - SABA PRN Mild persistent: symptoms present >2 days per week but not daily, nighttime awakenings 3-4 times per month, and inhaler use >2 days per week but not daily and not more than once on any day. The FEV1 is >80% of predicted. - Add low dose ICS Moderate persistent: symptoms are present daily, nighttime awakenings occur >1 time per week but not nightly, and an inhaler is required daily. FEV1 60-80%. - LABA with low dose ICS or medium dose ICS only Severe persistent: symptoms present throughout the day, nighttime awakenings up to 7 times per week, inhaler use several times per day, and an FEV1 <60% of predicted. - LABA with medium-high dose ICS, refer to Respi Cigarette smoking, increasing age (>/= 35yo), and exogenous oestrogen, particularly at the supraphysiologic doses used in contraceptives, all increase risk for vascular events such as venous thromboembolism and stroke. ANSWER: Choose progestin-only contraceptive options including etonogestrel implant, depot medroxyprogesterone acetate, the levonorgestrel-releasing IUD, and progestin-only oral contraceptive pills. Radiologic investigation for suspected stone disease