ABFM ITE exam-WITH 100 verified solutions.docx, Exams of Advanced Education

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ABFM ITE exam-WITH 100% verified solutions

long QT antibiotics Macrolides SIADH drugs "Vasopressin z Primary Cause Of Siadh iN MosT People" V-Vasopressin/vincristine P-Phenothiazine C-Cyclophosphamide/Chlorpromazine/Carbamazepine O-Oxytocin(high dose) S-Serotonin reuptake inhibitors N-Nicotine MosT-MAO inhibitor n T-Tricyclic antidepressants People-Phenothiazines... Actions against physician morals (e.g abortion) AFFP -> Dr. Not compelled, but provide resources on how to do. obesity in children 0-2y overweight >95th centile (no obese here) 2-18 normal 5-85, overwt >85, obese >= RSV rarely associated with coinfection no need for steroids in ttt

fever, crackles, decreased breath sounds Pneumonia 0-5 = strept = penicillin 5-15 = mycoplasma = azithro Cellulitis ttt MRSA = vancomycin PPV 1 doses in D+4C DM CSF leak Cochlear Implants Cyanotic CHD Chr BronchoPulm dysplasia one dose should be after age 2yr and be at least 2 months after PCV PPV revaccination Sickle cell Asplenia Immunocompromised with RF and leukemia HIV (3yr after 1st dose) most common cause of female infertility anovulation --> luteal phase progesterone

intoeing surgery at 8-10 yrs Prophylaxis in HIV CD4: <200 --> PC pneumonia by TMP/SMX =<150 --> Histoplasmosis by Azithro <100 --> Toxoplazma by TMP/SMX <50 --> Mycobacterium Avium Complex by Azithro Legg-Calve-Perthes ds s/o: 4-8 yrs, avascular necrosis of femoral head s/o: hip pain + limping Exam: limb length discrepancy, limited AB&IR Invest: sclerosis of prox femur + wide joint space PCOS Menstrual irreg, hirsutism, acne ttt: Lifestyle modification and wt loss --> metformin Anaphylaxis resistance to epinephrin In taking b-Blockers tt: Glucagon COPD Dx Spiro post BD: FEV1/FVC <70%

Thyroid nodule dx TSH --> low --> RN scan '--> N or high --> FNA if >1cm Nodules <1cm --> FUP Campylobacter ttt Erythromycin if resistant (south east Asia) Azithro (500qd for 3d) CRVO Dx (central retinal vein occlusion) hx: sudden painless loss of vision, no redness exam: tortous dilated retinal veins +- cotton wool spots Afferent pupillary defect on same side False +ve urine results Opioids: Dextromethorphan, codeine, Diphenhydramine Amphetamine: Ibuprofen, FluroQ, Pseudoephedrine Blood: myoglobin Emergency airway Cricothyroid membrane

HRT effects decreases: Fractures, Endom Ca Increases: CHD, stroke, BrCa, Dementia, GB ds, VTE results of the WHI (women's health initiative) Tamoxifen effects decreases: Fractures, BrCa Increases: VULVET V: Vasomotor s/o U: Urinary Incontinence L: leg cramps V: Vaginal dryness, itching, discharge E: Endom Ca T: Thromboembolism VTE Prolonged recovery from sports concussion headache >60hrs Fatigue/fogginess

=4 s/o at injury onset ttt if non of above: gradual graded return to activity Opioid side effects Long term: Hypogonadism Long lasting: Constipation (PolyEthGlyc for prophylaxis)

Gromet tubes (tympanostomy) if AOM >3/6ms or >4/yr with last in prev 6ms Muscle power grades 0 = no contraction 1 = contraction but no movement 2 = movement with no gravity 3 = movment againts gravity no resistance 4 = movement with little resistance 5 = movement with more resistance (normal) Lung Ca screen 55-80yr + smoking >30 pkyr + current smoker (or quit< 15yr) Cluster headache s/o: tearing, rhinorrhea unilat + unilat headache ttt: Abortive: Oxygen, Sumatriptan Prophylactic: Verapamil Birth weight regain in 14 days weight increases 30gm/d in 1st yr of life

doubles in 4-5ms triples by 1st yr Decreased warfarin effect Hypothyroidism, hyperlipidemia, diabetes, visceral Ca, vit K intake --> increase dose Increased warfarin effect Malnutrition, Malabs, cachexia, scurvy, fever, infections, hyperthyroidism, hypermetabolic states, hepatorenal failure, heart failure, biliary obstruction, vit K deficiency Hypoglycemia most with Glyburide Calcium citrate advantage no relation to stomach acid or to meals Dengue fever By: Aedes Mosquito IP: 3-14d s/o: spiking fever, hage lab: leucopenia, thrombocytopenia (hence hage), hemoconcentration, high AST ALT ttt: supportive, no Aspirin or NSAIDS yellow fever

as dengue but with jaundice Polymialgia rheumatica ttt Prednisone 15mg/d over 1-2yrs slow taper OR Methylpred 120mg IM/3wk Response in 48 hrs is diagnostic Don't use NSAIDs Immunosuppresion ttt e:

• prednisone 20mg/d at least 2 wks
• 6-mercaptopurine or Azathio
• Methotrex
• Infliximab
• Severe protein/caloric malnutrition OGTT test values in GDM 75gm:
• fasting 92
• 1hr 180
• 2hr 153 50gm:
• 1hr 140

100gm:

• Fasting > 95 mg/dL.
• 1 hr > 180 mg/dL.
• 2 hr > 155 mg/dL.
• 3 hr > 140 mg/dL. ttt of hyperphosphatemia Sevelamir (in 2ndry hyperpara in CRF), it blocks intestinal absorption of phosphate hypophosphatemia
• Medical emergency
• occurs in refeeding syndrome in recovering malnourished pts by 2nd or third day
• weakness, confusion, dysrhythmias, respiratory failure, heart failure, hypotension, ileus, metabolic acidosis, seizures, coma, and sudden death Anorexia Nervosa arrhythmia Sinus bradycardia IBS diarrhea predominant ttt: Citalopram, loperamide testing: check for celiac ds by anti-ttg Esophageal Adenocarcinoma increased in GERD and Obesity

Pertussis Dx: Nasopharyngeal culture and PCR ttt: Azithromycin Prophylaxis: Pre-exposure: DTap (must in pregnant regardless of status) Post-exposure: Azithromycin (TMP/SMX 2nd line) Give within 3wks from s/o start, within 6wks in children and pregos. JNC Targets:

• 140/90 < 60 no comorbs
• 150/90 > 60 no comorbs
• 140/90 > 18 in DM, CKD (summary: all <140/90, exept >60 no comorbs) Do's: start with CCBs or thiazides in Blacks Don'ts: No ACE + ARB Don't start with b-Blockers COPD exacerbation Prednisolone 5 days

Lights criteria PLeural: protein fluid/serum > 0. LDH fluid/serum > 0. Absolute LDH > 0. = Exudate (infections, pulm embolism) Mirena IUD # Liver ds, BrCa High risk bites Cat, Hand, Near prosthetic joint, DM, venous/lymph compromise, Crush, puncture, delayed presentation Geriatric changes more body fat Less lean mass, GFR, tubular excretion So

• More distribution of fat sol drugs (e.g diazepam) --> give lower dose
• increase elimination half life of fat sol drugs
• less vol of distrib in water sol drugs (e.g digoxin) --> give lower dose Newborn with pneumonia

Chlamydia at 3-16wks s/o: cough, tachypnia exam: crackles, conjunctivitis (no fever, no toxic) image: XR> diffuse infiltration, hyperinflation, ttt: oral erythromycin takes weeks Distal finger fractures Mallet finger: extensor tendon problem --> splint in extension 8wks Jersey finger: flexor tendon problem --> refer to surgery dt risk of tendon retraction Bipolar disorder ttt Acute mania: lithium/divalproex Maintenance ttt: lithium/valproate/lamotrigine/quetiapine Spirometry low FEV1 , low FVC, low ratio --> obstructive N FEV11, low FVC, N ratio --> restrictive Low DLCO + obstructive --> emphysema, COPD Low DLCO + restrictive --> IPF Just Low DLCO --> vascular causes: PE, pHTN, Anemia SCFE Adolescent, overweight, african-american

ttt: no weight bearing, Surgery Meralgia parasthetica Adolescent female, obese, tight clothes ( اديب نايكار) s/o: upper thight numbness Impingment of lat cut nerve of thigh Ostler Weber Rendu syndrome heridetary hagic telangiectasia Screen for pulm AV malform by Echo Orthostatic hypotension ttt Fludrocortisone, Midodrine, Physostigmine Loeffler syndrome lung Ascariasis or Schistosomiasis transient fever, cough, hemoptysis Neonatal CPR if HR< Neonate cyanosis ttt

1. Supplemental oxygen

2. exclude DDx

• hyaline memb ds (RDS) --> newborns
• Choanal atresia --> NGT bedside
• Pneumonia, pneumothx --> CXR
• Anemia, sepsis --> labs

3. ttt cause or observe if Transient Tachypnea of newborn (TTN)
4. bag-mask --> intubation if life threatening high sens/spec for carpal tunnel S Flick sign Myocarditis dilated cardiomyopathy ACEi Smoking cessation ttt side effects Vernicicline --> increase weight gain Bupropion --> decrease seiure threshold Onchomycosis ttt oral terbinafine (# liver ds) Sexual dysfunction in depression drugs Most: paroxitine Least: Bupropion

SSRI for hot flashes Escitalopram Ankle brachial index <= 0.9 in PAD

1.4 in atherosclerosis & long stand DM (not reliable) USPSTF HCV screening if born 1945-1965 one time screen Hemochromatosis HFE gene testing if transferrin > 54% OR ferritin > Pediatric hernia referral Umbilical --> unresolved by 3-5yr or incarceration anytime Inguinal --> immediate for repair in 1st yr Quetiapine warning sudden cardiac death more stroke risk

Bisphosphonates SE Atypical femoral shaft fractures, Jaw osteonecrosis, Oesophagitis with ulcers Colon Ca screening hyperplastic aden OR 1-2 tubular aden (<10mm) : 10 yrs

2 or >10mm or any villous: 3 yrs Normal >50yr every 10yr by colonoscope, or FOBT+sigmoido every 5yr in FHx HNPCC at age 25 every 1-2 yr in FHx FAP at 12yr annual in FHx of CoCa start at 40 or 0yrs b4 dx age whichever earlier

Raynauds ds drugs ttt: Nifidipine #: b-Blockers BP in children according to Age, Sex, Height (ASH :D) Hyperaldost (conn's S) HTN + hypoK Dx: Aldost >15 , Renin/Aldo > Aldosterone suppression test to confirm

HIV preExp prophyl Emtricitabine/Tenofovir Check: HIV Ab within 7d before ttt, pregnancy test, creat clear, HBV Ab, STDs Croup kids 6m - 3y dt parainfluenza give dexa 0.15-0.6 mg/kg single dose OSteoporosis in males Mult Myel, HIV, Hyperpara, hyperAldos Resistant HTN causes 60% OSA 20% Conn's 20% RAS problem Rotator cuff tendinitis injection location in subacromial space HIV screen All 15-65yrs

Screening in pregos 11-16wk: Asymp bacteruria 24-28wk: GDM 35-37wk: GBS infection low risk stress fracture ttt non weight bearing Ca and vit D heals in 6-10wk Addison's ds Dx Hypotension, Hyperkalemia (عكس Conn's) anorexia, fatigue, muscle pain, orthostasis Vitilligo, hyperpigmentation Dx by 8am S.Cortisol --> Confirm by Cosyntropin Stim test Male hypogonadism Dx Morning total testost Hip labral tear +FABER and FADIR MRI diagnostic

Ulnar collat overhead throwing, +ve moving valgus test Medial epicond Golfer's elbow Flexor & pronator tendinopathy Lat epicond Tennis elbow Conservative good long term, Physical therapy good short term, steroids decrease pain upto 6 wk but bad long term Biceps tendino ant elbow pain, cubital pain with resisted supination Triceps Tendino Post elbow pain on resisted extension Cubital tunnel synd ulnar neuropathy, numbness ulnar side forearm, if prolonged = intrinsic hand muscle weakness Intranasal Flu vaccin

Live attenuated indicated 2-49 healthy non prego effective >killed in children 2-6yr #pregos, old farts >50, Asthma, COPD Fever in Alcohol withdrawal Delerium Tremens ttt seisures in alcohol withdrawals BZDs (e.g Chlordiazepoxide) Mult Scler flare up Steroids Serotonin Synd Fever and HTN in pt on antipsycho drugs also dt SSRI + Dextromethorphan ttt: BZDs then CyproHeptaDin