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Flashcards in Missed Questions Deck (52)
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0
Q

What is the most common cause of death following bariatric surgery?

A

Pulmonary embolus

1
Q

In the elderly, levothyroxin replacement should be started at what percentage of the starting dose in the non-elderly adult patient?

A

60 to 75%

2
Q

Which oral medication is most effective in lowering postprandial blood sugars?

A

Exanatide or Byetta

3
Q

What is the definition of TIA?

A

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.

4
Q

What is the antibiotic of choice for empiric treatment of asymptomatic bacteria in a pregnant woman?

A

Cephalexin

5
Q

Of the following list, which is the greatest risk factor for premature onset of labor?

Concurrent STD, low socioeconomic status, uterine anomaly, and history of mid second trimester spontaneous loss of pregnancy.

A

Concurrent STD

6
Q

A patient has sleep apnea, leg swelling, a BMI of 44.1, a respiratory rate of 12, a blood pressure of 120/78, and O2 sat of 86% on room air, with normal EKG and chest x-Ray. Pulmonary function testing shows a restrictive pattern. abnormal blood tests include only a significantly elevated bicarbonate level.

Which of the following treatments has been shown to be likely to reduce this patient’s mortality rate? ACE inhibitors, nebulized albuterol, CPAP or BiPAP, high-dose diuretics, or continuous oxygen therapy

A

CPAP or BiPAP

Note: this patient has Pickwickian syndrome with chronic daytime hypoxia and carbon dioxide retention.

7
Q

What are some of the risks and benefits of vacuum assisted deliveries?

A

Vacuum assisted delivery has higher rates of neonatal cephalohematoma and retinal hemorrhage compared with forceps delivery. Vacuum assisted delivery is associated with less maternal soft tissue trauma when compared to forceps delivery. Compared to spontaneous vaginal delivery, the likelihood of severe perineal laceration is increased. Both forceps and vacuum assisted delivery are associated with an increased risk of shoulder dystocia and it is higher in vacuum assisted delivery.

8
Q

What is the most effective method to assist a patient in smokeless tobacco cessation?

A

Behavioral interventions. Mint snuff as a substitute and medications have not been shown to be effective including nicotine team patches or gum.

9
Q

Which of the following antidepressants would be most appropriate for an elderly man with decreased appetite and insomnia and depression: nortriptyline, bupropion, amitriptyline, mirtazapine , or trazodone?

A

Mirtazapine. It has serotonergic and not nor adrenergic properties and is associated with increased appetite and weight gain it may be particularly useful for patients with insomnia and weight-loss. Trazodone maybe useful but as it is not recommended as a primary antidepressant because it causes sedation and orthostatic hypotension at therapeutic doses.bupropion would aggravate his patients insomnia. Tricyclics are no longer considered first-line treatments because of their side effects,including cardiotoxicity.

10
Q

What is the most appropriate advice for a patient who has passed six calcium oxalate stones over the past four years?

A

The patient should follow a low sodium, restricted-protein diet with increased fluid intake. Oxalate restriction is also helpful which means restriction of foods such as spinach, chocolate, tea and nuts. Potassium citrate should be taken at meals to increase urinary pH and urinary citrate.

11
Q

What are appropriate treatments for benign essential tremor?

A

Beta blockers or primidone.

12
Q

What is the appropriate treatment for 23 month old child with a two day history of fever to 102° F, cough, wheezing, mildly labored breathing, and no response to aerosolized bronchodilator?

A

This is a typical case of bronchiolitis. Bronchodilator treatment maybe tried once and discontinued if there is no improvement. Treatment usually consists of supportive care only, including oxygen and IV fluids if indicated. Steroids, antibiotics and decongestants are of no benefit.

13
Q

Lumbar spine stenosis will typically cause increased pain in the lower limbs with what activities?

A

Spine extension and walking downhill. The pain is typically improved with spine flexion, walking uphill and sitting.

14
Q

What are the most common pathogens in previously untreated acute superficial foot infections in diabetics?

A

Aerobic gram-positive staph aureus and beta-hemolytic streptococcal groups A, B, and others.

15
Q

A 67-year-old male has a 0.5 cm adenomatous polyp with low-grade dysplasia found on screening colonoscopy. When should the next colonoscopy done?

A

According to the multi society task force on colorectal cancer, patients with one or two small, (i.e. less than 1 cm) tubular adenomas, including those with only low-grade dysplasia, should have their next colonoscopy in 5 to 10 years.

16
Q

What are the clinical features a posterior tibial tendinopathy? What is its treatment?

A

It is most commonly seen in women over the age of 40. the patient usually recalls no trauma although the injury may occur from twisting the foot by stepping in a hole. There is pain and swelling and tenderness posterior to the medial malleolus. With the patient standing on tiptoe the heel does not deviate in varus alignment as it should. A single toe raise should reproduce the pain.

Over time this injury can elongate the midfoot and hindfoot ligaments, causing a painful flatfoot deformity. Treatment should be immobilization in a cast boot or short leg cast for 2 to 3 weeks.

17
Q

What test is the best predictor of vancomycin efficacy?

A

Trough serum levels.

18
Q

What metabolic abnormality is very likely to be seen in patients with stage four kidney disease?

A

Hyperparathyroidism. Current guidelines recommend monitoring calcium and phosphate every 3 to 6 months, and bone specific alkaline phosphatase every 6 to 12 monthso in these patients.

19
Q

In a patient with suspected diarrhea predominant irritable bowel syndrome, what test should always be performed to rule out another disease?

A

Testing for celiac disease. About 4% of people with diarrhea predominant or mixed presentation irritable bowel syndrome have biopsy-proven celiac disease.

20
Q

What is sevelamer? What is it used for?

A

It blocks intestinal absorption of phosphate, which lowers parathyroid hormone excretion. It is particularly useful in patients with chronic renal failure who have hyperparathyroidism. This is because decreasing serum phosphate lowers the feedback stimulation of parathyroid hormone secretion by the parathyroid gland, which is often excessive in chronic renal insufficiency.

21
Q

What types of kidney stones should be treated with urine acidification versus alkalinization?

A

Acidification: calcium phosphate stones and struvite (magnesium ammonium phosphate) stones.

Alkalinization: uric acid, cystine, and calcium oxalate stones.

22
Q

What is the optimum treatment for a 57-year-old woman with hyperthyroidism with increased levels of free T4 and free T-3 and proptosis?

A

Methimazole or Tapazole.

Radioactive iodine treatment can precipitate thyroid storm, and therefore patients with elevated free T3 or free T4 levels should be treated with methimazole prior to its administration. In addition, radioactive iodine treatment can worsen pre-existing orbitopathy. Propylthiouracil or PTU has been associated with reports of severe hepatocellular damage, and should be avoided.

23
Q

Do inhaled corticosteroids improve or worsen hoarseness?

A

Inhaled corticosteroids, especially fluticasone, may cause hoarseness

24
Q

Name two cardio selective beta blockers

A

Metoprolol and atenolol

25
Q

What is the recommended total length of thromboprophylaxis following major orthopedic surgery?

A

35 days is optimal, with 14 days being the minimum amount.

26
Q

What drugs used for pain should be completely in avoided in patients with cirrhosis?

What drugs are relatively safe?

A

NSAIDs, due to the risk of precipitating hepatorenal syndrome.

Pregabalin and gabapentin are not metabolized by the liver and can be quite helpful. Acetaminophen still can be used safely in dosages of 2 to 3 g per day. Tramadol is also safe in patients with cirrhosis.

27
Q

What one time test for all adults 65 years and under should be performed according to the USPS TF?

A

HIV testing, regardless of risk factors.

28
Q

What is the recommendation for pregnant women or women within two weeks postpartum who have signs and symptoms of flu with a positive influenza swab?

A

Oseltamivir (Tamiflu)

29
Q

What does an ankle brachial index of over 1.4 indicate in a person with symptoms of claudication?

A

This indicates non-compressible calcified arteries. It accounts for 20% of all adults with peripheral artery disease. Work up for the claudication should include MRI or CT angiography of the lower extremities. More reliable information can often be obtained by using toe pressures to calculate a toe-brachial index rather than an ankle brachial index.

30
Q

What is the treatment for hypoactive sexual desire disorder in women?

A

Topical testosterone, either in patch or gel form has shown consistent improvement in arousal, desire, fantasy, orgasm and overall satisfaction. CBT has not been shown to be helpful nor have oral estrogen or oral sildenafil.

31
Q

What treatments have been shown to be helpful for irritable bowel syndrome?

A

Both the SSRIs and tricyclic antidepressants have been shown to be of benefit. Fiber has not been shown to be beneficial. Antibiotics may be beneficial including neomycin which is used only in constipation predominant IBS. Lubiprostone is also only indicated for patients with chronic constipation. Alosetron is FDA approved to treat severe diarrhea predominant IBS only in women who have not improved with conventional therapy. It has uncommon but serious adverse effects including ischemic colitis and death. Other potentially beneficial therapies include peppermint oil, psychological treatments, exercise, and probiotics.

32
Q

What hematological findings are typical for myelodysplastic syndrome?

A

Anemia, thrombocytopenia, neutropenia, or any combination of these. Anemia occurs in 80 to 85% of patients and is typically macrocytic.

33
Q

How often should women between age 30 to 65 years old be screened for cervical cancer assuming they have negative cytology ± negative HPV testing?

A

Screening is recommended every three years if the test is cytology only and it is negative. Cervical cytology and HPV testing is recommended to be repeated every five years if negative.

34
Q

What drug should be used for a suspected anaerobic lung infection?

A

Clindamycin. Although metronidazole has some activity against anaerobes, its activity does not include the anaerobic species often involved in pulmonary infections.

35
Q

Who is legally responsible for notifying a patient of her mammogram results?

A

The facility performing the mammogram.

36
Q

Should patients with a diagnosis of gonorrhea be retested? When?

A

All patients with a diagnosis of gonorrhea should be retested at 3 to 6 months due to a high rate of reinfection.

37
Q

What psychiatric/neurologic drug is associated with an increased risk of agranulocytosis?

A

Carbamazepine or Tegretol. They have a 5 to 8 fold increased risk of developing agranulocytosis.

38
Q

What is the recommended HPV immunization schedule for girls and boys?

A

The quadrivalent vaccine should be given to both girls and boys beginning at 11 to 12, though it may be offered as early as 9. It is a three vaccine series, given at 02 and six months. There is no restriction on catch-up doses in terms of length of time since the last vaccine, though insurance may not cover doses given given to older children.

39
Q

What epileptic drugs induce hepatic metabolism of estrogen and progestin? What contraceptives are appropriate and women taking these medications?

A

Carbamazepine, oxcarbazepine, phenobarbital, phenytoin, and topiramate.

Good contraceptive choices in these women include levonorgestrel IUD and copper IUD as well as single rod implantable progestin systems.

40
Q

What beneficial health effect of vitamin D is supported by the best evidence?

A

The reduction of falls in community dwelling older adults.

41
Q

How many seconds does it take the average healthy adults over age 60 to perform the timed get-up-and-go test?

A

10 seconds

42
Q

What is the optimal management of congenital undescended testis in a baby?

A

Referral for surgery, optimally to be done between six and 12 months.

43
Q

What are the criteria for sepsis?

A

Temperature greater than 38.3°C, a wbc count of greater than 12,000, a respiratory rate greater than 20, and a source of probable infection.

44
Q

What medications are associated with B12 deficiency?

A

Metformin, proton pump inhibitors, and H2-blockers

45
Q

According to the ADA screening for diabetes in asymptomatic patients with no risk factors should begin at what age?

A

45

46
Q

At what percent increase of baseline creatinine should a recently started a CE inhibitors be stopped?

A

At an increase of 30% or more over baseline.

47
Q

Progestin only pills are most effective in which women?

A

In women who are exclusively breast-feeding. They are not as effective in pregnancy prevention and other circumstances.

48
Q

What is the most common bacterial pathogen isolated from critically ill patients with coinfection?

A

MRSA

49
Q

If volvulus is a suspected in a young child, what is the appropriate test to order?

A

An upper G.I. series. Abdominal ultrasonography is less sensitive and specific for malrotation.

50
Q

What drug combination has been shown to be particularly effective in African-Americans who have not responded to or are intolerant of standard care for CHF, (including diuretics, beta blockers and ACE or ARB).

A

Hydralazine and isosorbide dinitrate.

51
Q

What patients should receive vancomycin rather then metronidazole for Clostridium difficile diarrhea?

A

Patient should receive vancomycin if two more of the following factors are present: age greater than 60, temperature greater than 38.3, albumin less than 2.5, WBC greater than 15,000, creatinine increase of 50%.

Note that 125 mg PO QID is as effective as higher doses.