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Family |\Medicine |\Board |\Review |\
QUESTIONS |\WITH |\ANSWERS
A |\42-year-old |\Asian |\male |\presents |\for |\follow-up |\of |\elevated |\blood |\pressure. |\He |\has |\no |\additional |\chronic |\medical |\problems |\and |\is |
otherwise |\asymptomatic. |\An |\examination |\is |\significant |\for |\a |
blood |\pressure |\of |\162/95 |\mm |\Hg |\but |\is |\otherwise |\unremarkable. Laboratory |\Findings |\unremarkable Urine |\microalbumin |\negative According |\to |\the |\American |\College |\of |\Cardiology/American |\Heart |
Association |\ 2017 |\guidelines, |\which |\one |\of |\the |\following |\would |\be |
the |\most |\appropriate |\medication |\to |\initiate |\at |\this |\time? A) |\Clonidine |(Catapres), |\0.1 |\mg |\twice |\daily B) |\Hydralazine, |\ 25 |\mg |\three |\times |\daily C) |\Lisinopril/hydrochlorothiazide |(Zestoretic), |\10/12.5 |\mg |\daily D) |\Metoprolol |\tartrate |(Lopressor), |\ 25 |\mg |\twice |\daily E) |\Triamterene |(Dyrenium), |\ 50 |\mg |\daily |- |\CORRECT |\ANSWERS |
✔✔ANSWER: |\C This |\patient |\has |\hypertension |\and |\according |\to |\both |\JNC |\ 8 |\and |
American |\College |\of |\Cardiology/American |\Heart |\Association |\ 2017 |
guidelines, |\antihypertensive |\treatment |\should |\be |\initiated. |\For |
the |\general |\non-African-American |\population, |\monotherapy |\with |
an |\ACE |\inhibitor, |\an |\angiotensin |\receptor |\blocker, |\a |\calcium |
channel |\blocker, |\or |\a |\thiazide |\diuretic |\would |\be |\appropriate |\for |
initial |\management. |\It |\is |\also |\appropriate |\to |\initiate |\combination |
antihypertensive |\therapy |\as |\an |\initial |\management |\strategy, |
although |\patients |\should |\not |\take |\an |\ACE |\inhibitor |\and |\an |
angiotensin |\receptor |\blocker |\simultaneously. |\Studies |\have |\shown |\
that |\blood |\pressure |\control |\is |\achieved |\faster |\with |\the |\initiation |
of |\combination |\therapy |\compared |\to |\monotherapy, |\without |\an |
increase |\in |\morbidity. |\Lisinopril/hydrochlorothiazide |\would |\be |\an |
appropriate |\choice |\in |\this |\patient. |-Blockers, |\vasodilators, |- blockers, |\and |\potassium-sparing |\diuretics |\are |\not |\recommended |
as |\initial |\choices |\for |\the |\treatment |\of |\hypertension. During |\rounds |\at |\the |\nursing |\home, |\you |\are |\informed |\that |\there |
are |\two |\residents |\on |\the |\unit |\with |\laboratory-confirmed |\influenza. |\According |\to |\CDC |\guidelines, |\who |\should |\receive |
chemoprophylaxis |\for |\influenza? A) |\Only |\symptomatic |\residents |\on |\the |\same |\unit B) |\Only |\symptomatic |\residents |\in |\the |\entire |\facility C) |\All |\asymptomatic |\residents |\on |\the |\same |\unit D) |\All |\residents |\of |\the |\facility |\regardless |\of |\symptoms E) |\All |\staff |\regardless |\of |\symptoms |- |\CORRECT |\ANSWERS |
✔✔ANSWER: |\C In |\long-term |\care |\facilities, |\an |\influenza |\outbreak |\is |\defined |\as |
two |\laboratory-confirmed |\cases |\of |\influenza within |\ 72 |\hours |\in |\patients |\on |\the |\same |\unit. |\The |\CDC |
recommends |\chemoprophylaxis |\for |\all |\asymptomatic |\residents |\of |
the |\affected |\unit. |\Any |\resident |\exhibiting |\symptoms |\of |\influenza |
should |\be |\treated |\for |\influenza |\and |\not |\given |\chemoprophylaxis |
dosing. |\Chemoprophylaxis |\is |\not |\recommended |\for |\residents |\of |
other |\units |\unless |\there |\are |\two |\laboratory-confirmed |\cases |\in |
those |\units. |\Facility |\staff |\of |\the |\affected |\unit |\can |\be |\considered |
for |\chemoprophylaxis |\if |\they |\have |\not |\been |\vaccinated |\or |\if |\they |
had |\a |\recent |\vaccination, |\but |\chemoprophylaxis |\is |\not |
recommended |\for |\all |\staff |\in |\the |\entire |\facility.
polymicrobial |\infection. |\Pelvic |\ultrasonography |\may |\be |\used |\if |
there |\is |\a |\concern |\about |\other |\pathology |\such |\as |\a |\tubo-ovarian |
abscess. A |\24-year-old |\patient |\wants |\to |\start |\the |\process |\of |\transitioning |
from |\female |\to |\male. |\He |\has |\been |\working |\with |\a |\psychiatrist |
who |\has |\confirmed |\the |\diagnosis |\of |\gender |\dysphoria. |\Which |\one |\of |\the |\following |\would |\be |\the |\best |\initial |\treatment |\for |\this |
patient? A) |\Clomiphene B) |\Letrozole |(Femara) C) |\Leuprolide |(Eligard) D) |\Spironolactone |(Aldactone) E) |\Testosterone |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\E For |\patients |\with |\gender |\dysphoria |\or |\gender |\incongruence |\who |
desire |\hormone |\treatment, |\the |\treatment |\goal |\is |\to |\suppress |
endogenous |\sex |\hormone |\production |\and |\maintain |\sex |\hormone |
levels |\in |\the |\normal |\range |\for |\their |\affirmed |\gender. |\For |\a |\female- to-male |\transgender |\patient |\this |\is |\most |\easily |\accomplished |\with |\testosterone. |\When |\testosterone |\levels |\are |\maintained |\in |\the |
normal |\genetic |\male |\range, |\gonadotropins |\and |\ovarian |\hormone |
production |\is |\suppressed, |\which |\accomplishes |\both |\goals |\for |
hormonal |\treatment |\without |\the |\need |\for |\additional |\gonadotropin |\suppression |\from |\medications |\such |\as |\leuprolide. |\Clomiphene |
can |\increase |\serum |\testosterone |\levels, |\but |\only |\in |\the |\presence |
of |\a |\functioning |\testicle. |\Letrozole |\is |\an |\estrogen |\receptor |
antagonist, |\but |\it |\would |\not |\increase |\serum |\testosterone |\levels. |
Spironolactone |\has |\androgen |\receptor |\blocking |\effects |\and |\would |\not |\accomplish |\either |\of |\the |\hormone |\treatment |\goals.
Based |\on |\American |\Cancer |\Society |\guidelines |\for |\cervical |\cancer |
screening, |\when |\should |\HPV |\DNA |\co-testing |\first |\be |\performed |
along |\with |\Papanicolaou |\testing? A) |\At |\the |\onset |\of |\sexual |\activity B) |\At |\age |\ 21 C) |\At |\age |\ 25 D) |\At |\age |\ 30 E) |\At |\age |\ 35 |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\D According |\to |\American |\Cancer |\Society |\guidelines |\for |\cervical |
cancer |\screening, |\Papanicolaou |(Pap) |\testing should |\begin |\at |\age |\ 21 |\irrespective |\of |\sexual |\activity |\and |\should |
be |\continued |\every |\ 3 |\years |\until |\age |\29. |\The |\preferred |\screening |
strategy |\beginning |\at |\age |\ 30 |\is |\Pap |\testing |\with |\HPV |\co-testing, |
which |\should |\be |\continued |\every |\ 5 |\years |\until |\age |\65. |\Cervical |
screening |\may |\be |\discontinued |\at |\that |\time |\if |\the |\patient's |\last |
two |\tests |\have |\been |\negative |\and |\the |\patient |\was |\tested |\within |
the |\previous |\ 5 |\years. Long-term |\proton |\pump |\inhibitor |\use |\is |\associated |\with |\an |
increased |\risk |\for A) |\Barrett's |\esophagus B) |\gout C) |\hypertension D) |\pneumonia E) |\type |\ 2 |\diabetes |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\D Acid |\suppression |\therapy |\is |\associated |\with |\an |\increased |\risk |\of |
community-acquired |\and |\health |\care-associated |\pneumonia, |
which |\is |\related |\to |\gastric |\overgrowth |\by |\gram-negative |\bacteria.
|\She |\tries |\to |\go |\to |\bed |\at |\10:00 |\p.m. |\and |\wakes |\up |\at |\6:30 |\a.m. |
to |\start |\her |\day. |\She |\lies |\awake |\for |\an |\hour |\in |\bed |\before |\falling |
asleep |\and |\spends |\up |\to |\ 2 |\hours |\awake |\in |\the |\middle |\of |\the |\night |\trying |\to |\fall |\back |\asleep. |\Lately |\she |\has |\been |\feeling |\fatigued |
and |\having |\difficulty concentrating |\at |\work. |\You |\conduct |\a |\full |\history |\and |\physical |
examination |\and |\tell |\her |\to |\return |\in |\ 2 |\weeks |\with |\a |\sleep |\diary. |
At |\this |\follow-up |\visit |\you |\see |\from |\her |\diary |\that |\she |\is |\sleeping |
an |\average |\of |\5½ |\hours |\per |\night. |\Which |\one |\of |\the |\following |
would |\be |\the |\most |\appropriate |\recommendation? A) |\Set |\her |\alarm |\for |\5:30 |\a.m. B) |\Add |\a |\mid-afternoon |\nap C) |\Move |\her |\bedtime |\to |\9:00 |\p.m. D) |\Move |\her |\bedtime |\to |\12:30 |\a.m. E) |\Stay |\up |\for |\an |\ho |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\D This |\patient |\presents |\with |\symptoms |\of |\chronic |\insomnia. |
Cognitive-behavioral |\therapy |\for |\insomnia (CBT-I) |\and |\brief |\behavioral |\therapy |\for |\insomnia |(BBT-I) |\are |
effective |\nonpharmacologic |\treatments |\for |\chronic |\insomnia. |
Modified |\CBT-I |\and |\BBT-I |\can |\be |\administered |\by |\a |\primary |\care |
physician. |\The |\basic principles |\include |\stimulus |\control |(sleep |\hygiene) |\and |\sleep |
restriction. |\Reducing |\time |\in |\bed |\increases |\sleep |\efficiency. |\In |\this |\case, |\ 6 |\hours |\of |\time |\in |\bed |\would |\improve |\the |\patient's |\sleep |
efficiency |\and |\a |\bedtime |\of |\12:30 |\a.m. |\would |\accomplish |\this |
goal. |\Generally, |\reduced |\time |\in |\bed |\is |\accomplished |\by |
postponing |\bedtime |\rather |\than |\getting |\up |\earlier. |\Naps |\generally |\do |\not |\improve |\sleep |\efficiency. |\While |\getting |\out |\of |\bed |\is |
recommended |\after |\being |\in |\bed |\for |\ 30 |\minutes |\without |\falling |\
asleep, |\or |\being |\awake |\for |\ 30 |\minutes |\after |\being |\asleep, |\staying |\up |\for |\a |\prescribed |\period |\of |\time |\is |\not |\recommended. A |\45-year-old |\female |\presents |\to |\the |\emergency |\department |\with |\a |\1-week |\history |\of |\facial |\swelling |\and |\progressive |\dyspnea |\with |
exertion. |\She |\was |\diagnosed |\ 1 |\week |\ago |\with |\non-Hodgkin's |
lymphoma |\but |\her |\medical |\history |\is |\otherwise |\unremarkable. |
After |\hospital |\admission, |\which |\one |\of |\the |\following |\would |\be |\the |
most |\appropriate |\next |\step |\in |\the |\management |\of |\this |\condition? A) |\Intravenous |\antibiotics B) |\Urgent |\chemotherapy |\and |\radiation C) |\Urgent |\chemotherapy |\and |\plasmapheresis D) |\Urgent |\echocardiography E) |\Urgent |\bronchoscopy |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\B Because |\of |\the |\prevalence |\of |\cancer |\in |\the |\United |\States, |\it |\is |
important |\for |\family |\physicians |\to |\recognize oncologic |\emergencies. |\This |\patient |\presents |\with |\signs |\and |
symptoms |\related |\to |\superior |\vena |\cava |\syndrome, |\which |\is |
caused |\by |\compression |\of |\the |\superior |\vena |\cava. |\This |\is |\most |
often |\caused |\by |\lung |\cancer |\or |\lymphoma, |\but |\it |\can |\also |\be |
related |\to |\indwelling |\catheters, |\lymph |\nodes, |\or |\metastatic |
tumors. |\After |\ensuring |\that |\the |\patient |\is |\hospitalized |\and |\stable, |\the |\initial |\treatment |\options |\include |\intravenous |\corticosteroids, |
chemotherapy, |\radiation, |\and |\occasionally |\intravascular |\stenting. |\Antibiotics |\are |\not |\warranted |\because |\this |\condition |\is |\not |\the |
result |\of |\an |\infection. |\Hyperviscosity |\syndrome |\is |\another |
oncologic |\emergency |\associated |\with |\leukemia, |\multiple |
myeloma, |\and |\Waldenström's |\macroglobulinemia. |\It |\is |\treated |
with |\chemotherapy |\and |\plasmapheresis. |\Echocardiography |\and |\
A |\16-year-old |\female |\presents |\with |\chronic |\acne |\on |\her |\nose, |
forehead, |\and |\chin |\consisting |\of |\a |\few |\comedones |\and |\a |\few |
mildly |\inflamed |\papules |\and |\pustules. |\She |\says |\it |\is |\minimally |
improved |\after |\ 12 |\weeks |\of |\daily |\adapalene |\0.1% |\gel. |\There |\are |
no |\scars |\or |\cysts. |\The |\patient |\would |\like |\to |\try |\to |\achieve |\better |
control. |\Which |\one |\of |\the |\following |\would |\you |\recommend |\at |\this |
time? A) |\Continue |\adapalene |\0.1% |\gel |\for |\ 12 |\more |\weeks B) |\Add |\clindamycin |(Cleocin |\T) |\1% |\gel |\for |\up |\to |\ 12 |\weeks C) |\Add |\clindamycin |\1% |\gel |\for |\maintenance D) |\Stop |\adapalene |\0.1% |\gel |\and |\start |\clindamycin |\1% |\gel |\for |
maintenance E) |\Stop |\adapalene |\0.1% |\gel |\and |\start |\erythromycin |\2% |\gel |\for |
maintenance |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\B Family |\physicians |\are |\often |\asked |\to |\manage |\mild |\to |\moderate |
acne |\vulgaris. |\Topical |\retinoids |\such |\as |\adapalene |\and |\benzoyl |
peroxide |\are |\first-line |\therapy |\and |\a |\trial |\of |\therapy |\is |\typically |\8- 12 |\weeks. |\Topical antibiotics |\may |\be |\added |\to |\topical |\retinoids |\or |\benzoyl |\peroxide |
to |\achieve |\better |\symptom |\control. |\To |\decrease |\emerging |
antibiotic |\resistance, |\studies |\support |\limiting |\antibiotic |\use |\to |\ 12 |
weeks |\except |\in |\severe |\cases, |\not |\using |\antibiotics |\as |
monotherapy, |\and |\using |\clindamycin |\rather |\than |\erythromycin. |
Adding clindamycin |\gel |\rather |\than |\erythromycin |\gel |\for |\up |\to |\ 12 |\weeks |
is |\recommended |\for |\this |\patient |\at |\this |\time. A |\32-year-old |\female |\who |\is |\one |\of |\your |\longtime |\patients |\calls |
you |\because |\of |\a |\24-hour |\history |\of |\painful |\urination |\with |\urinary |
frequency |\and |\urgency. |\She |\is |\otherwise |\healthy |\and |\does |\not
have |\any |\fever, |\chills, |\back |\pain, |\or |\vaginal |\discharge. |\She |\uses |
an |\oral |\contraceptive |\pill |\and |\states |\that |\her |\last |\menstrual |
period |\was |\normal |\and |\occurred |\last |\week. |\Which |\one |\of |\the |
following |\would |\be |\most |\appropriate |\at |\this |\time? A) |\Empiric |\antibiotic |\treatment B) |\A |\urinalysis C) |\A |\urine |\culture D) |\Plain |\abdominal |\radiographs E) |\Pelvic |\ultrasonography |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\A This |\patient |\has |\symptoms |\of |\acute |\simple |\cystitis |\and |\does |\not |
have |\any |\symptoms |\that |\would |\suggest |\a |\complicated |\urinary |
tract |\infection |\or |\vaginal |\infection. |\In |\these |\cases |\treatment |\with |
oral |\antibiotic |\therapy may |\be |\prescribed |\without |\further |\evaluation |(SOR |\B). |\Simple |
cystitis |\is |\a |\clinical |\diagnosis |\and |\a |\urinalysis |\and |\urine |\culture |
are |\not |\necessary. |\The |\patient |\does |\not |\have |\any |\symptoms |\that |
warrant |\evaluation |\with |\abdominal |\radiographs |\or |\pelvic |
ultrasonography. A |\70-year-old |\female |\develops |\thrombocytopenia |\during |\a |
prolonged |\hospitalization |\for |\endocarditis. |\Her |\current |
medications |\include |\scheduled |\unfractionated |\heparin |\injections |
for |\venous |\thromboembolism |\prophylaxis. |\You |\suspect |\heparin- induced |\thrombocytopenia |(HIT). |\Assuming |\that |\her |
thrombocytopenia |\is |\caused |\by |\HIT, |\which |\one |\of |\the |\following |\is |
the |\most |\likely |\complication? A) |\Anaphylaxis B) |\Disseminated |\intravascular |\coagulation C) |\Hemorrhage
preventing |\falls |\in |\community-dwelling |\older |\adults |\at |\increased |
risk |\for |\falls? A) |\Calcium |\supplementation B) |\Vitamin |\D |\supplementation C) |\Supportive |\footwear D) |\Exercise |\classes E) |\Cognitive-behavioral |\therapy |- |\CORRECT |\ANSWERS |
✔✔ANSWER: |\D In |\the |\United |\States |\falls |\are |\the |\leading |\cause |\of |\injury-related |
morbidity |\and |\mortality |\among |\older |\adults. |\The |\U.S. |\Preventive |
Services |\Task |\Force |(USPSTF) |\concluded |\with |\moderate |\certainty |
that |\exercise |\interventions |\provide |\a |\moderate |\net |\benefit |\in |\fall |
prevention |\in |\community-dwelling |\adults |\ 65 |\years |\of |\age |\or |\older |\who |\are |\at |\increased |\risk |\for |\falls |(B |\recommendation). |\The |
USPSTF |\also |\concluded |\with |\moderate |\certainty |\that |
supplementation |\with |\calcium |\and |\vitamin |\D |\has |\no |\clear |\benefit |
in |\preventing |\falls |\in |\older |\adults. |\Environmental |\modifications |
and |\psychological |\interventions |\lack |\sufficient |\evidence |\for |\fall |
prevention. A |\42-year-old |\male |\presents |\with |\a |\10-day |\history |\of |\hoarseness. |
He |\also |\has |\a |\2-month |\history |\of |\reflux |\symptoms |\and |\has |\been |
taking |\antacids |\as |\needed. |\He |\does |\not |\take |\any |\other |
medications. |\There |\is |\no |\history |\of |\fever, |\weight |\loss, |\night |
sweats, |\or |\appetite |\changes. |\You |\note |\that |\the |\patient |\is |\hoarse, |
and |\a |\physical |\examination |\is |\normal, |\including |\HEENT, |
cardiovascular, |\and |\pulmonary |\examinations. |\He |\is |\a |\member |\of |
a |\community |\choir |\that |\rehearses |\twice |\a |\week. |\In |\addition |\to |
voice |\rest, |\which |\one |\of |\the |\following |\would |\be |\most |\appropriate |
at |\this |\time?
A) |\Supportive |\care |\only B) |\Azithromycin |(Zithromax) C) |\Omeprazole |(Prilosec) D) |\A |\course |\of |\prednisone |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\C This |\patient |\has |\hoarseness |\that |\has |\been |\present |\for |\less |\than |\ 2 |\weeks. |\In |\addition |\to |\voice |\rest, |\treatment |\in |\patients |\with |\a |
history |\of |\GERD |\should |\include |\a |\3- |\to |\4-month |\trial |\of |\a |\high- dose |\proton |\pump |\inhibitor |(SOR |\C). |\In |\patients |\with |\hoarseness |
lasting |\longer |\than |\ 2 |\weeks |\without |\an |\apparent |\benign |\etiology, |
the |\larynx |\should |\be |\examined |\by |\direct |\or |\indirect |\laryngoscopy |
(SOR |\C). |\Antibiotics |\and |\oral |\corticosteroids |\should |\not |\be |\used |
for |\the |\empiric |\treatment |\of |\hoarseness |\in |\the |\absence |\of |\signs |
and |\symptoms |\that |\suggest |\an |\underlying |\cause. A |\57-year-old |\male |\with |\a |\history |\of |\heart |\failure |\sees |\you |\for |
follow-up. |\He |\describes |\symptoms |\of |\mild |\dyspnea |\on |\exertion |
with |\ordinary |\activities |\such |\as |\shopping |\or |\yard |\work. |\An |
echocardiogram |\shows |\an |\ejection |\fraction |\of |\37%. |\According |\to |
the |\New |\York |\Heart |\Association |\criteria, |\this |\patient's |\heart |\failure |\would |\be |\classified |\as |\which |\one |\of |\the |\following? A) |\Class |\I B) |\Class |\II C) |\Class |\III D) |\Class |\IV |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\B The |\appropriate |\classification |\of |\heart |\failure |\is |\important |\for |
monitoring |\the |\disease. |\The |\most |\common currently |\used |\system |\is |\the |\New |\York |\Heart |\Association |(NYHA) |
functional |\classification. |\In |\this |\system, |\class |\I |\is |\defined |\as |\heart
|\sensitivity, |\but |\MRI |\is |\preferred |\due |\to |\the |\greater |\specificity |\and |\ability |\to |\inform |\alternate |\diagnoses. A |\24-year-old |\female |\presents |\with |\progressively |\worsening |
vulvar |\pain |\for |\ 3 |\days. |\On |\examination |\a |\3×3-cm |\tender, |
fluctuant |\mass |\is |\noted |\on |\the |\right |\labia |\minora. |\She |\had |\a |
similar |\episode |\of |\this |\problem |\last |\year. |\Which |\one |\of |\the |
following |\would |\be |\the |\most |\appropriate |\management? A) |\Expectant |\management B) |\Fine-needle |\aspiration C) |\Incision |\and |\drainage D) |\Marsupialization E) |\Excision |\under |\general |\anesthesia |- |\CORRECT |\ANSWERS |
✔✔ANSWER: |\D The |\most |\appropriate |\management |\of |\a |\recurrent |\Bartholin |\gland |\abscess |\would |\be |\marsupialization, |\which |\has |\a |\0% |\recurrence |
rate |\at |\ 6 |\months. |\Local |\anesthesia |\can |\be |\used |\in |\the |\office |\to |
effectively |\treat Bartholin |\gland |\abscesses |\and |\sedation |\is |\not |\required |(SOR |\A). |\If |\the |\Bartholin |\gland |\abscess |\is |>5 |\cm, |\referral |\to |\a |\gynecologist |
is |\recommended. |\Expectant |\management, |\fine-needle |\aspiration, |\or |\incision |\and |\drainage |\would |\likely |\lead |\to |\recurrence. Which |\one |\of |\the |\following |\should |\NOT |\be |\consumed |\during |
pregnancy |\due |\to |\a |\potentially |\high |\mercury |\content? A) |\Catfish B) |\Crawfish, |\shrimp, |\and |\lobster C) |\Flounder |\and |\haddock
D) |\Salmon |\and |\trout E) |\Shark |\and |\swordfish |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\E Larger |\ocean |\fish |\that |\consume |\other |\fish |\may |\accumulate |
mercury |\levels |\that |\can |\cause |\neurologic problems |\when |\consumed, |\so |\these |\fish |\should |\be |\avoided |\by |
children |\and |\pregnant |\or |\nursing |\women. |\Shark |\and |\swordfish |
are |\among |\the |\fish |\with |\the |\highest |\mercury |\content. |\Catfish, |
crawfish, |\shrimp, |\lobster, |\flounder, |\haddock, |\salmon, |\and |\trout |
have |\the |\least |\amount |\of |\mercury. An |\18-month-old |\female |\is |\brought |\to |\your |\office |\by |\her |\mother |
for |\evaluation |\of |\a |\cough. |\The |\patient |\has |\had |\low-grade |\fevers |
and |\a |\runny |\nose |\for |\ 2 |\days. |\She |\now |\has |\a |\cough |\that |\is |\worse |
at |\night. |\On |\examination |\she |\has |\a |\temperature |\of |\37.5°C |
(99.5°F), |\a |\pulse |\rate |\of |\ 120 |\beats/min, |\a |\respiratory |\rate |\of |
30/min, |\and |\an |\oxygen |\saturation |\of |\92% |\on |\room |\air. |\She |\is |
noted |\to |\have |\hoarseness, |\mild |\inspiratory |\stridor, |\and |\a |\barking |
cough. |\She |\does |\not |\have |\drooling |\or |\a |\muffled |\voice. |\Which |\one |
of |\the |\following |\should |\be |\ordered |\to |\confirm |\the |\diagnosis? A) |\No |\further |\testing B) |\A |\CBC C) |\A |\viral |\culture D) |\Rapid |\antigen |\testing E) |\A |\radiograph |\of |\the |\neck |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\A This |\patient |\has |\croup, |\which |\is |\diagnosed |\clinically |\and |\no |
further |\testing |\is |\usually |\indicated. |\A |\CBC |\is |\nonspecific |\and |\is |
usually |\only |\indicated |\if |\a |\bacterial |\cause |\of |\stridor |\is |\suspected, |
such |\as |\bacterial |\tracheitis, |\epiglottitis, |\retropharyngeal |\abscess, |
or |\peritonsillar |\abscess. |\Viral |\cultures |\and |\rapid |\antigen |\testing |
should |\be |\reserved |\for |\instances |\in |\which |\the |\patient |\fails |\to |\
pancreatitis |\does |\not |\generally |\present |\with |\improved |\pain |\after |
eating. |\Irritable |\bowel |\syndrome |\is |\not |\associated |\with |\fever, |
rectal |\bleeding, |\anemia, |\or |\perianal |\fistulas. |\Ulcerative |\colitis |\is |
not |\associated |\with |\perianal |\lesions. A |\34-year-old |\female |\at |\ 32 |\weeks |\gestation |\presents |\with |\a |\right- sided, |\pounding |\headache |\that |\began |\ 8 |\hours |\ago |\and |\is |\similar |
to |\headaches |\she |\has |\had |\in |\the |\past. |\She |\is |\sensitive |\to |\light |
and |\sound, |\and |\has |\vomited |\several |\times |\since |\the |\onset |\of |
pain. |\She |\has |\taken |\acetaminophen |\without |\relief. |\She |\takes |
prenatal |\vitamins |\but |\no |\other |\routine |\medications. |\On |
examination |\her |\blood |\pressure |\is |\normal. |\Which |\one |\of |\the |
following |\would |\be |\the |\most |\appropriate |\treatment |\for |\this |
patient? A) |\Dihydroergotamine B) |\Metoclopramide |(Reglan) C) |\Naproxen D) |\Oxycodone |(OxyContin) E) |\Sumatriptan |(Imitrex) |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\B Metoclopramide |\and |\acetaminophen |\are |\the |\only |\two |
medications |\considered |\safe |\for |\abortive |\migraine |\treatment |
during |\pregnancy |(SOR |\B). |\The |\dopamine |\antagonist |\antiemetics |
are |\considered |\second-line |\abortive |\treatments |\in |\the |\general |
population. |\Dihydroergotamine |\should |\not |\be |\used |\during |
pregnancy |\due |\to |\its |\oxytocic |\properties |\and |\the |\potential |\risk |\of |
intrauterine |\growth |\restriction |\with |\its |\use. |\NSAIDs |\are |\not |
considered |\safe |\during |\pregnancy, |\particularly |\in |\the |\first |\and |
third |\trimesters. |\Opioids |\are |\only |\moderately |\useful |\for |\migraine |
treatment |\and |\should |\be |\avoided |\during |\pregnancy |\due |\to |\their |
abuse
potential. |\Triptans |\are |\generally |\considered |\safe |\during |\the |\first |
trimester |\but |\not |\in |\the |\second |\and |\third |\trimesters. |\Their |\use |
has |\been |\associated |\with |\uterine |\atony, |\increased |\risk |\of |
bleeding |\during |\delivery, |\and |\increased |\risk |\of |\preterm |\birth. Which |\one |\of |\the |\following |\U-100 |\insulin |\products |\has |\the |\longest |\duration |\of |\action? A) |\Degludec |(Tresiba) B) |\Glargine |(Lantus) C) |\Isophane |\NPH |(Humulin |\N) D) |\Lispro |(Humalog) E) |\Regular |(Humulin |\R) |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\A Among |\the |\available |\U-100 |\insulin |\products, |\the |\one |\with |\the |
longest |\duration |\of |\action |\is |\ultralong-acting |\degludec, |\which |
lasts |\ 42 |\hours. |\The |\duration |\of |\action |\of |\rapid-acting |\lispro |\is |\3- 6.5 |\hours, |\short-acting |\regular |\is |\5-8 |\hours, |\intermediate-acting |
isophane |\is |\12-16 |\hours, |\and |\long-acting |\glargine |\is |\11-24 |\hours. When |\performing |\a |\geriatric |\assessment, |\which |\one |\of |\the |
following |\is |\an |\instrumental |\activity |\of |\daily |\living? A) |\Bathing B) |\Dressing C) |\Transferring |\between |\the |\bed |\and |\a |\chair D) |\Using |\the |\telephone E) |\Using |\the |\toilet |- |\CORRECT |\ANSWERS |\✔✔ANSWER: |\D The |\foundation |\of |\geriatric |\assessment |\is |\assessing |\the |
individual's |\ability |\to |\perform |\tasks |\required |\for |\living. |\Activities |\
