ABFM ITE Exam With 100% Correct And Verified Answers A+ Graded, Exams of Advanced Education

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ABFM ITE Exam With 100% Correct And

Verified Answers A+ Graded

CAP antibiotic that causes VF - Correct 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 - Correct Answer-GLP1 receptor agonists e.g. Exenatide SGLT-2 inhibitor e.g. Canagliflozin Screening test with greatest potential for over diagnosis - Correct Answer-PSA Clinical manifestation of amyotrophic lateral sclerosis - Correct Answer-Asymmetric leg weakness Opioid to avoid in palliative patient with severe hepatic dysfunction - Correct 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 - Correct Answer-Adults 55- 80yo with 30 pack year history and currently smoking or quit within last 15 years NOAC with reversal agent - Correct Answer-Dabigatran Reduces alcoholism but creating an acute ethanol sensitivity - Correct Answer- Disulfiram Antidepressant to be avoided in the elderly - Correct Answer-Paroxetine (associated with more anticholinergic effects) SSRIs > SNRIs, atypical antipsychotics may be added for resistant depression Age group between which American Academy of Pediatrics recommends administration of an autism-specific screening tool - Correct Answer-18-24 months old Most common neurological complication of Paget's disease of the bone - Correct Answer- Most common cardiac complication of Lyme disease - Correct Answer-Heart blocks

Examination finding of those with bacterial vaginosis - Correct Answer-Vaginal pH >4. (normal vaginal pH should be acidic) Most common cause of medication-related adverse events across health care settings in the United States - Correct Answer-Antibiotics Screening for asymptomatic carotid artery stenosis - Correct Answer-Not recommended In anaphylaxis, which drug is most likely helpful in preventing the need for intubation? - Correct Answer- Barrett's oesophagus with no dysplasia - Correct Answer- Positive family history of colorectal cancer - Correct Answer-Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age or two first-degree relatives diagnosed at any age should be advised to start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. Most common cause of hearing loss in newborns - Correct Answer-Genetic inheritance Lab findings in Von Willebrand disease - Correct Answer- U.S. federal labor law requires companies with >50 employees to provide which benefits for employees who are nursing mothers - Correct Answer- Influenza vaccination in those with potential egg allergy - Correct 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? - Correct Answer-Helps to assess the risk of falling

Antidepressant that can prolong QT interval to be avoided in those on concomitant atypical antipsychotics - Correct 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 - Correct Answer-Azithromycin Prevented by washing hands frequently Most effective medication for treating fibromyalgia - Correct 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? - Correct Answer- 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? - Correct Answer-Coagulopathy Chronic medication that can cause B12 deficiency - Correct Answer-Metformin Strongest risk factor for primary hypertension in children and adolescents - Correct 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? - Correct Answer-Pseudomonas Treatment of erythrasma (Wood's lamp coral pink/red fluorescence, fine-scaled with a cigarette-paper appearance) caused by Corynebacterium minutissimum infection - Correct Answer-Erythromycin Which radiologic funding of a lung nodule is most predictive of malignancy? - Correct Answer- Which investigation is routine in all newborns with Down syndrome? - Correct Answer- Echocardiography Treatment duration for provoked vs unprovoked PE - Correct Answer-3 months and indefinitely respectively

In patients with symptoms indicative of pneumonia or heart failure, what investigations can be done to determine treatment of either condition or both? - Correct Answer-BNP and procalcitonin levels How to increase HDL (good cholesterol)? - Correct Answer-Add niacin Dietary recommendation in diverticulosis - Correct Answer-High fibre or take fibre supplements Side effects of prolonged PPI use - Correct Answer-C diff infection, hypoMg, hip fracture Which antiemetic blocks dopamine stimulation in the chemoreceptor trigger zone? - Correct Answer-Metoclopramide Little League shoulder is a repetitive use injury causing disruption at the proximal growth plate of the humerus - Correct Answer-Proximal humeral epiphysitis. Can be seen on plain radiographs as widening, demineralization, or sclerosis at the growth plate. Taking beta carotene and Vit E to prevent cancer and heart disease - Correct Answer- Fluoride supplementation should be started at what age when primary water supply is deficient in fluoride - Correct Answer-6 months Medications that can reduce serum Vitamin D levels - Correct Answer-Rifampicin, Phenytoin Isolated posterior cruciate ligament tear - Correct Answer-Direct blow to the anterior tibia whilst knee is in flexion What should patients be periodically monitored for whilst on Amiodarone? - Correct Answer-TSH Drug of choice in depressed persons with cardiovascular disease - Correct Answer- SSRIs Antibiotics causing prolonged QT - Correct Answer-Macrolides Benign nocturnal limb pains of childhood (previously known as "growing pains") - Correct Answer-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. No further work-up necessary.

Treatment of OSA in children - Correct Answer-Adenotonsillectomy What is most likely seen with diastolic dysfunction? - Correct Answer-A preserved ejection fraction Positive hip FADIR and FABER testing - Correct Answer-Hip labral tear Childhood vaccination carrying risk of febrile seizure in up to 2 weeks post- administration - Correct Answer-MMR Elbow Moving Valgus Stress Test - Correct Answer-Ulnar collateral ligament injury In United Stated, at what age is it recommended for cow's milk be introduced? - Correct Answer-12 months Treatment for lateral dislocation of the patella - Correct Answer-Medically directed pressure on the patella while extending the leg Treatment of SSRI overdose - Correct Answer- Finkelstein's test - Correct 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 - Correct Answer-Sickle Cell Disease Excessive femoral anteversion with normal mobility - Correct 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 - Correct Answer-Repetitive exposure to fearful stimuli Tricyclic antidepressants and SSRIs are also effective Effective treatment for post-herpetic neuralgia - Correct Answer-Topical agents such as lidocaine patches and capsaicin cream or patches, as have the oral agents gabapentin, pregabalin, and amitriptyline. Empiric treatment of pyelonephritis - Correct Answer-Ciprofloxacin Light's criteria: exudative if pleural:serum protein >0.5 and LDH >0.6 (or >2/3 upper limit of normal LDH) - Correct Answer-Pulmonary embolism

• Pleural effusions associated with malignancy, pneumonia, viral illness, and asbestosis tend to be exudative. Brachial cleft cyst - Correct Answer-Congenital lesion, usually results in solitary cyst located in lateral neck anterior to the SCM; may have sinus to skin. Antibiotic prophylaxis for dog bites - Correct Answer-Hand involvement Leading cause of death worldwide - Correct Answer-Cardiovascular disease Which one of the following potential bioterrorism agents requires treatment with 60 days of continuous antibiotics? - Correct Answer-Anthrax What is a pet reptile most likely to transmit to its human contacts? - Correct Answer- Salmonella Supplement to be added shortly after birth to infants who are fully or partially breastfed - Correct Answer-Vitamin D 400IU daily Continuing until the child is consuming at least 500 mL/day of formula or milk containing vitamin D What should be monitored whilst on testosterone replacement therapy? - Correct Answer-Haematocrit (may increase)
• Polycythaemia is thus an absolute contraindication to starting testosterone Treatment of narcolepsy - Correct 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 - Correct Answer-Fe and transferrin saturation Most common cause of chest pain in children - Correct Answer-Musculoskeletal When should patient with hyperplastic polyps on colonoscopy be due for repeat surveillance? - Correct 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 - Correct Answer- Mmethylmalonic acid

Most common cause of child abuse in USA - Correct Answer-Neglect Most common cancer diagnosed in the USA - Correct 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? - Correct Answer-American trypanosomiasis (Chagas disease) A U.S. Preventive Services Task Force "D" recommendation indicates - Correct 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? - Correct Answer-BMI Which agent used to reduce PPH secondary to stony should be avoided in asthmatics?

• Correct 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? - Correct Answer- Lice Treatment of acute otitis media in children - Correct 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) - Correct Answer-PEG preferred more than Lactulose as less side effects and increased effectiveness Prophylactic TB treatment - Correct Answer-Isoniazid for 9m What does the U.S. Preventive Services Task Force recommends for prevention of falls in community-dwelling adults >/=65 years of age who are at increased risk for falls? - Correct Answer-Exercise interventions What are koplik spots pathogmonic for? What causes this? - Correct Answer-Measles Anti-DM medication that increases risk of UTI as well as thrush (in women) - Correct Answer-SGLT2-inhibitors (Dapa, Empa)
• May be used as second line choice in those intolerant of Metformin When titrating the dosage of opioids, the CDC recommends that you should also consider prescribing naloxone when the opioid dosage reaches what morphine milligram equivalent (MME) per day threshold? - Correct Answer- Investigation for spina bifida - Correct Answer-Ultrasound

Goal for fasting blood glucose reading in GDM - Correct Answer-<95 mg/dL What is the recommended first line agent to prevent steroid-induced osteoporosis? - Correct Answer-Bisphosphonates Remission in alcohol use disorder - Correct Answer-Early (3-12m), Sustained (>12m) Groups with highest prevalence of syphilis - Correct Answer-Men who have sex with men Features of foetal alcohol syndrome - Correct Answer-In addition to clinodactyly (curved 5th finger), it is also associated with camptodactyly (flexion deformity of the fingers), other flexion contractures, radioulnar synostosis, scoliosis, and spinal malformations. Avulsion tuberosity fracture of proximal 5th metatarsal - Correct Answer-Treatment of nondisplaced tuberosity avulsion fractures is conservative. Options include elastic wrapping, ankle splints and low-profile walking boots or casts. Weight bearing is allowed as tolerated. Treatment should be continued until symptoms abate—usually within three to six weeks. Treatment of depression associated with erectile dysfunction - Correct Answer- Bupropion or Mirtazapine Treatment of menopausal symptoms - Correct Answer-Black cohosh Diagnostic criteria for PCOS - Correct Answer-NEED 2 OF 3

• Oligo or anovulation
• Clinical/biochem signs of hyperandrogenism
• Sonographic evidence of polycytic ovary Indication for carotid endarterectomy - Correct Answer->70% stenosis of carotid vessels for symptomatic patient Ringed appearance of oesophagus - Correct Answer-Is indicative of eosinophilic oesophagitis to treat with PPIs Medication that increases risk of osteoporosis - Correct Answer-Ranitidine, Thiazolidinediones (glitazones) Greatest modifiable risk factor of AAA - Correct Answer-Cigarette smoking Immunotherapy can prevent recurrence of severe allergic reactions triggered by - Correct Answer-Wasp (insect) stings

Infant factor to look out for in potential breastfeeding issues - Correct 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? - Correct Answer- Turner's syndrome

• Karyotyping Treatment of life-threatening heat stroke - Correct Answer-Aggressive ice water immersion Colonoscopy after 75 years old - Correct 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 - Correct Answer-Hypersegmented polymorphonuclear WBCs Biopsy proven coeliac disease monitoring after being on gluten-free diet - Correct Answer-IgA Tissue Transglutaminase antibody Hypokalaemia in DKA due to insulin causing K being pushed into cells - Correct Answer-Potassium replacement Buprenorphine therapy should be initiated when patient is in mild to moderate withdrawal from opioids - Correct Answer-Patents with opioids in their bloodstream or who are not in the early stages of withdrawal, may experience acute withdrawal. Pregnancy related dental disorders - Correct Answer-Cavities, gingivitis, loose teeth, periodontitis, tooth erosion What can help to delay definitive surgical therapy in carpal tunnel syndrome? - Correct Answer-Corticosteroid injections What to do after a tick bite to prevent Lyme disease? - Correct Answer-Doxycycline 200mg once or Amoxicillin
• This is only recommended for tick attachment longer than 36 hours, or of unknown duration. At what grade level should health care materials be written? - Correct Answer-

At what age should a child's Hb be checked as recommended by the AAP? - Correct Answer-12 months Antibiotic that increases risk of AAA rupture - Correct Answer-Fluoroquinolones (floxacins) An otherwise healthy 55-year-old male who is visiting from Arizona presents to your office with a 4-week history of intermittent fevers, night sweats, dry cough, weight loss, and myalgia. The patient has no other recent history of travel. - Correct Answer-Valley Fever (medical name coccidioidomycosis or "cocci" for short) is an infection in the lungs caused by the fungus coccidioides spp., which grows in soils in areas of low rainfall, high summer temperatures and moderate winter temperatures, such as: throughout Arizona, the San Joaquin and Central Valleys of California, southern parts of Nevada, New Mexico and western Texas, east-central Utah, south-eastern Washington, and the semiarid and arid soils of Central and South America. First-line pharmacotherapy for diabetic gastroparesis - Correct Answer-Metoclopramide, Erythromycin Expedited Partner Therapy (EPT) in STDs - Correct Answer-Treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner. Antibiotic time-out - Correct Answer-Occurs 48-72h after first administration, part of antibiotic stewardship programme to ensure judicious use. Prehn's sign - Correct Answer-Physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion. Treatment of epididymitis - Correct 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? - Correct 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. - Correct 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 - Correct 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 - Correct Answer-Oral Prednisolone (recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10- days) Ottawa Ankle rules: negative i.e. ankle sprain - Correct 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 - Correct Answer-Alcohol use Assessing response to oral iron therapy in iron deficiency anaemia - Correct Answer- Reticulocyte count Use of IV contrast in those with shellfish allergies - Correct Answer-No correlation Shoulder pain with weak internal rotation - Correct Answer-Subscapularis Shoulder pain with weak external rotation - Correct Answer-Infraspinatus, teres minor Shoulder pain with weak abduction - Correct Answer-Supraspinatus, deltoid First line imaging modality for acute abdominal pain in children - Correct Answer- Ultrasonography First line anti-hypertensives in African-Caribbean patients - Correct Answer-Calcium- channel blockers, Thiazides (e.g. Chlorthalidone) Hospice care eligibility is based on - Correct Answer-Life expectancy (6 months or less) Depression in adolescents (12-18yo) should be screened annually with PHQ-2 then PHQ-A - Correct Answer-Psychotherapy SSRIs: Fluoxetine, Citalopram

• Venlafaxine should be avoided in adolescents because it is associated with a statistically increased risk of suicidal behavioupr or ideation.

GLP-1 receptor agonist that lowers risk of recurrent cardiovascular events - Correct Answer-Liraglutide Sickle cell disease increases risk of stroke - Correct Answer-All sickle cell patients 2- years of age should be screened with transcranial Doppler ultrasonography Non-specific lower back pain - Correct Answer-Does not require imaging

• An initial plain film would be appropriate if there were a history of recent significant trauma, or even a history of minor trauma in an elderly patient.
• Immediate MRI would be appropriate in the presence of other red flags NSAIDs then skeletal muscle relaxant e.g. Cyclobenzaprine A walking program is the best choice for long-term benefit because it is much more affordable than physical therapy Occupations causing silicosis - Correct Answer-Stone cutting, sand blasting, mining, and quarrying HOCM systolic murmur intensifies with Valsava's and is the most common primary cardiomyopathy - Correct Answer-First-line treatment with beta-blockers, CCBs (non- dipines) if beta-blockers not tolerated BPSD of dementia can be treated (off-label) with antipsychotics - Correct Answer- Aripiprazole produces small reductions in behavioral and psychological symptoms of dementia, and it has the least adverse effects of the atypical antipsychotics. 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 - Correct 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. - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer-St John's wort Splint for distal radial fracture - Correct Answer-Sugar tong Worrisome characteristics of palpitations - Correct 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 - Correct 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 - Correct 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 - Correct Answer-Spot urine PCR The only evidence-based treatment that confers significant benefits to children with autism is - Correct Answer-Intensive behavioral interventions, which should be initiated before 3 years of age.

What is the advantage of the recombinant zoster vaccine (Shingrix) compared to the live zoster vaccine (Zostavax)? - Correct Answer-Increased efficacy (97% vs 51%) Which one of the following findings in a patient's history greatly increases her risk of an accidental opiate-related overdose? - Correct Answer-Concurrent use of opiates with Benzodiazepines The most common cause of chronic cough in adults is upper airway cough syndrome. - Correct Answer-Patients might have nasal symptoms such as rhinorrhoea or congestion. Physical findings can include swollen turbinates and posterior pharyngeal cobblestoning, or they can be unremarkable. Initial treatment may include the use of decongestants, oral or intranasal antihistamines, intranasal corticosteroids, or saline nasal rinses. Constipation-predominant IBS - Correct Answer-Polyethylene glycol, a long-chain polymer of ethylene oxide, is a large molecule that causes water to be retained in the colon, which softens the stool and increases the number of bowel movements. Pain control with opioids - Correct Answer-Most orally administered immediate-release opioids such as morphine, oxycodone, and hydromorphone reach their peak effect at about 1 hour, at which time additional medication can be given if the patient is still in pain. Intravenous opioids reach their peak effect at about 10 minutes and intramuscular and subcutaneous opioids at about 20-30 minutes. Pulmonary hypertension secondary to COPD - Correct Answer-Supplemental oxygen should be recommended when the PaO2 is <60 mm Hg, because it has been shown to improve mortality by lowering pulmonary arterial pressures. Type of anti-hypertensives that can reduce severity of OSA - Correct Answer- Aldosterone antagonists. Resistant hypertension is common in patients with obstructive sleep apnea. Resistant hypertension is also associated with higher levels of aldosterone, which can lead to secondary pharyngeal oedema, increasing upper airway obstruction. PCOS treatment - Correct Answer-Not desiring pregnancy: low-dose COCP (caution melasma), Spironolactone, Finasteride Desiring pregnancy: Letrozole > Clomiphene Initial evaluation of hypogonadism - Correct Answer-FSH and LH Internal tibial torsion - Correct 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. - Correct 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 - Correct Answer- Obesity Preferred initial evaluation of acute mesenteric ischaemia - Correct Answer-CT Angiography Contraindication of oestrogen-containing contraception methods - Correct Answer- Smokers >35 years of age and in patients with migraine with aura. Highest cure rate of basal cell carcinoma - Correct Answer-Mohs surgery Pharmacotherapy to reduce alcohol consumption and increase abstinence - Correct Answer-Acamprosate Valvular heart disease in Marfan's syndrome - Correct Answer-Aortic insufficiency/regurgitation in 80-100%, increases with age and is progressive. May also be associated with mitral valve prolapse. Haemoptysis work-up - Correct Answer-CXR normally but CT Chest if high risk for malignancy (age, smoking history) 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

• Correct 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 - Correct 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 - Correct Answer-From 24w Proximal fifth metatarsal stress fracture (Jones fracture) management - Correct Answer- Particularly prone to non-union and completion of the fracture. Because complete non- weight bearing or surgical intervention may be necessary with this high-risk fracture, MRI is indicated as the most sensitive test.

• It has been shown that active patients have shorter healing times and return to activity sooner with surgical management.
• If the nonsurgical option is chosen the patient is given an initial posterior splint and followed up in 3-5 days, then placed in a short non-weight-bearing cast for 6 weeks, at which time a repeat radiograph is taken. If the radiograph shows healing, the patient can return to gradual weight bearing. If the radiograph does not show proper healing, then the period of non-weight bearing is extended. Adolescent physiologic gynaecomastia - Correct Answer-One half of all adolescent males, usually bilateral but left sided more common if unilateral, typically resolves 6- 24m after onset. Identify highest percentage of previously unrecognised chronic Hepatitis C - Correct Answer-One-time screening for all adults from 18-79 Yo First-line treatment for persistent allergic rhinitis - Correct Answer-Intranasal steroids on top of allergen avoidance and patient education Most reliable measure to protect children from lead toxicity in the United States - Correct Answer-Eliminating the sources of lead in the community What should be avoided to minimise the risk of postpartum haemorrhage? - Correct Answer-Routine episiotomy Initial management for VF and pulseless VT - Correct Answer-Defibrillation Mild transaminitis with negative HepB and HepC - Correct Answer-Serum ferritin (to check for hereditary haemochromatosis) on top of USS Liver Treatment of mid substance Achilles tendinopathy - Correct Answer-An eccentric gastrocnemius-strengthening program Pseudofolliculitis barbae is a common condition affecting the face and neck in people with tightly curled hair. - Correct Answer-Clippers generally result in a less close shave and contribute less. Olecranon bursitis - Correct 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 - Correct Answer-SC LMWH e.g. Dalteparin, Enoxaparin Medications to decrease mortality in patients with symptomatic heart failure - Correct Answer-Aldosterone antagonists, beta-blockers Anticoagulation in those with malignancy - Correct Answer-SC LMWH preferred (NOACs not studied in area of malignancy yet) Mental health screening for refugees - Correct Answer-Depression, anxiety, and post- traumatic stress disorder AST:ALT ratio for alcoholic liver disease - Correct Answer-3: Perioperative management of chronic anticoagulation therapy - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer-Both Sitagliptin, a DPP-4 inhibitor, and Liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution. Head lice in children - Correct Answer-If suspected, the child should remain in class and should not be treated unless there is a clear diagnosis and live lice are seen. They should however, be discouraged from close contact with others until treated appropriately with a pediculicide. Nits are louse eggs and do not necessarily represent an active, infectious case of head lice. After first cycle of treatment, apart from home eradication measures and regular nit combing, patient may return to class with retreatment in a week's time. Falsely lowers HbA1c in diabetics - Correct Answer-Haemolytic anaemia, HAART for HIV, chronic liver disease, pregnancy, Vit C and E, acute blood loss Lithium toxicity, more prevalent in the elderly - Correct Answer-Often presents with signs and symptoms related to the gastrointestinal tract (nausea, vomiting, and diarrhoea, which can further worsen toxicity), heart (arrhythmias and conduction delays), and central nervous system (coarse tremors, ataxia, agitation, and confusion). Common cause of neonatal sepsis - Correct Answer-GBS, E coli Most common cause of tinnitus - Correct Answer-SNHL Pearly Penile Papules (PPP) - Correct Answer-Common and benign, and present as small, skin coloured, dome-shaped papules in a circular pattern around the coronal sulcus. Angiokeratomas (may appear solely on the glans of the penis, but are also found on the scrotum, abdomen, thighs, groin, and extremities) - Correct Answer-Usually asymptomatic, circumscribed, red or bluish papules.

When found on shaft of the penis, the suprapubic region, or the sacral region; can be associated with Fabry disease. Chronic tension-type headaches - Correct Answer-Amitriptyline may reduce headache duration and severity Painful diabetic peripheral neuropathy - Correct 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. - Correct 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 - Correct 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 - Correct Answer-Oral syringe should be provided In treatment of Bipolar Disorder, treatment with SSRI as monotherapy should be avoided - Correct 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 - Correct 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 - Correct 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 - Correct Answer-Acute glomerulonephritis Mallet finger - Correct 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 - Correct 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 - Correct 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 - Correct Answer-24h urinary free cortisol Obesity hypoventilation syndrome (carbon dioxide retention - PaCO2 >45 mm Hg, in an individual with a BMI > 30 kg/m2) - Correct Answer-Restrictive pattern on spirometry Sever's disease - Correct Answer-Most common cause of heel pain in children and adolescents 8-12 years of age. Voice hoarseness - Correct Answer-Complete vocal rest, including no whispering or throat clearing, is the most effective and quickest initial remedy for short-duration laryngitis, whether viral or due to vocal overuse or abuse. Second Degree Heart Block (Mobitz I) - progressively prolonged PR then dropped QRS

• Correct Answer-A pacemaker is not recommended in patients who are asymptomatic. It is recommended in symptomatic patients, however, and is guided by electrophysiologic studies. Primary prevention of cardiovascular disease - Correct Answer-Low-dose aspirin therapy is recommended in patients 50-59 years of age who have a risk of CVD of at least 10% (not <50yo regardless of dose due to increased risk of GI bleeds) A U.S. hospital or birthing center seeking to be certified as "Baby Friendly" by the Baby- Friendly Hospital Initiative - Correct Answer-Providing no other food or fluids to breastfeeding infants without a medical indication Pituitary microadenoma - Correct Answer-Microadenomas <10 mm in size that are secreting prolactin may be treated with a dopaminergic agent such as Bromocriptine. This will lower the prolactin level and shrink the adenoma. Nonprolactin-secreting adenomas, especially those >10 mm in size (macroadenomas), require neurosurgical evaluation.

Bariatric surgery - Correct Answer-Inclusion criteria include a BMI >/= 40 kg/m2 without coexisting medical problems or a BMI >/= 35 kg/m2 with one or more severe obesity- related co-morbidities such as diabetes mellitus.

• It does result in reduced all-cause mortality and more weight loss. Thereafter:
• Avoid NSAIDs
• 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 - Correct 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. - Correct 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 - Correct Answer-Diagnostic test of choice is analysis of synovial fluid obtained through arthrocentesis. Most appropriate psychotherapy for patients with obsessive-compulsive disorder - Correct 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. - Correct 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 - Correct 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? - Correct Answer-75yo (stop after 85yo) Classic early finding of muscular dystrophies - Correct Answer-Head lag when sitting up Most commonly associated with oligohydramnios - Correct 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 - Correct Answer-Purulent infections have a higher likelihood of being caused by MRSA, so coverage with trimethoprim/sulfamethoxazole or clindamycin (caution C diff) would be appropriate; but IV Vancomycin if hospitalised. In nonpurulent skin infections, amoxicillin/clavulanate or cephalexin would be appropriate choices. The mother of a newborn infant is concerned because her baby's eyes are sometimes crossed. Assuming the intermittent eye crossing persists, which one of the following is the most appropriate age for ophthalmologic referral? - Correct Answer-Proper coordination should be achieved by age 4-6 months Clinically diagnosable acute bacterial prostatitis, and no further testing, including imaging, is required to establish the diagnosis. - Correct Answer-Culture of a midstream voided urine may aid in identifying the pathogen, but prostate massage should be avoided because it may increase the risk of bacteraemia. Hospitalised patients with persistently raised blood glucose - Correct Answer-Insulin therapy should be initiated, starting at a threshold of 180 mg/dL. Once insulin therapy is started, a target glucose range of 140-180 mg/dL is recommended for the majority of hospitalized patients, regardless of whether they have a critical illness.

This patient has findings consistent with influenza, including a rapid onset of fever, nausea, and sore throat, and negative pulmonary findings. Influenza is considered a clinical diagnosis and confirmation of the diagnosis with laboratory testing is not required. - Correct Answer-Treatment of influenza is recommended for individuals at a high risk of influenza-related complications. High-risk individuals include those with chronic lung disease; cardiovascular (excluding hypertension), renal, hepatic, haematologic, or neurologic disease; or age >65. Children on long-term aspirin therapy, and pregnant and postpartum women are also considered high risk. Most common cause of hypercalcaemia - Correct Answer-Primary hyperparathyroidism Other causes of hypercalcaemia include thiazide diuretics, lithium, vitamin D intoxication, hyperthyroidism, milk alkali syndrome from excessive calcium antacid ingestion, adrenal insufficiency, and lymphoma. RSV bronchiolitis mainstay supportive care with adequate hydration - Correct Answer- Infants with respiratory rates >60/min may have poor feeding secondary to difficulty breathing and oral rehydration may increase the risk of aspiration. In these cases, nasogastric or intravenous fluids should be administered. 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 - Correct 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 - Correct Answer-20% Hyperthyroid treatment in pregnancy - Correct 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 - Correct Answer-Doxycycline

Pre-op evaluation - Correct 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) - Correct 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 - Correct 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 - Correct 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) - Correct 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. Other recommended conservative therapy includes modified rest for 6-8 weeks with continuation of activities of daily living and limited walking. Normal activity can be resumed after 2-3 weeks with no pain. Additionally, the use of NSAIDs, ice, and stretching, as well as cross-training is recommended. Uterine fibroid tumors (leiomyomas) are the most common tumors of the female reproductive tract. - Correct Answer-Many fibroids are asymptomatic and are discovered incidentally, with observation being the preferred management in this situation. The risk of malignant leiomyosarcoma is exceedingly small (0.23% in one

study) and there is a risk of side effects or complications from other treatment modalities. Diarrhea that develops in patients with ileal Crohn's disease or following ileal resection is usually due to increased amounts of bile acid remaining in the stool. This affects colonic secretion and motility and various protein factors in the gut, resulting in the development of bile acid diarrhoea (BAD). - Correct Answer-A therapeutic trial with a bile acid sequestrant such as cholestyramine is most often used for both the diagnosis and treatment of BAD. Reducing fat intake may also be beneficial. Fiber supplementation may help to produce a more formed stool and could be used as an adjunct treatment when appropriate. Treatment of PTSD - Correct Answer-An SSRI or SNRI should be used first as monotherapy and should be optimized before an additional agent is added. Prazosin is an effective augmenting therapy for patients with PTSD and sleep disturbance/nightmares. Injections for shoulder impingement syndrome - Correct Answer-Subacromial injection of a corticosteroid may provide pain relief for up to several weeks but does not alter long-term outcomes. Acne appearing at which one of the following ages should prompt detailed endocrine laboratory testing for possible underlying systemic disease? - Correct Answer-Mid- childhood i.e. 5yo A 5-year-old male is brought to your office after passing an intestinal worm. He lives on a farm with cattle, pigs, and dogs. He has never travelled very far from home. He does not have any respiratory symptoms or diarrhoea, but has experienced some abdominal bloating. - Correct 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 - Correct Answer-Penile enlargement before 9yo