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AAFP Board Review Questions - GEN MED 5

aafp board review questions

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Lab test for polymyalgia rheumatica
What is a boxer's fracture?
- what is the maximum accepted volar angulation before surgery is recommended?
- conservative therapy?
Boxer's fx: fracture of the 5th metatarsal
- up to 40 degrees
- tx with ulnar gutter splint
What are the types of hearing loss?
- Differentiate them based on etiologies
- Describe Webber and Rinne's testing
Conductive and Sensorineuro

- pathophys: secondary to external or middle ear problem
- otitis media, cerumen impaction, otosclerosis
- Weber: lateralizes to affected ear
- Rinner: Bone conduction > air conduction

- pathophys: secondary to inner ear/chochlear problem or central causes
- noise exposure, prebyscusis, central etiologies
- Weber: lateralizes to opposite ear
- Rinner: Bone conduction < air conduction
Describe the characteristics of prebyscusis
- location
- hearing loss frequency
- type of hearing loss
- Bilateral
- high pitched hearing loss
- sensorineuro
What is the best method of gestational age estimation (time of US and fetal anatomy)?
Crown-rump length at 10 weeks
- After 11 weeks, biparietal diameter and femur length start to play a role as well
Erythema multiforme
- #1 etiology
- other etiologies
- description of lesion pattern
- timing of resolution
- #1 etiology: Herpes Simplex Virus
(Mycoplasma pneumoniae, vaccines, fungal infections)

- PATTERN: target lesions that persist for over 1 week, involving palms and soles of feet
- round wheal-like lesions, similar to urticarial lesions but are round.

- RESOLUTION: 3-5 weeks
Recommended work-up for persistent hematuria
urology consult for CT Urography or IV pyelography
What are the motor side effects of anti-psychotics?
- describe them
dystonia, parkinsonism, akathisia, withdrawal dyskinesia, tardive dyskinesia

DYSTONIA: spastic contractions of muscles
- tx: benztropine as anti-cholinergic
AKATHISIA: inner restlessness, "inability to sit down"
- tx: propranolol
PARKINSONISM: hand tremors, bradykinesia, shuffling gait
- benztropine or Benadryl as anti-cholinergic
WITHDRAWAL DYSKINESIA: secondary to stopping drug suddenly
- tx: taper med
TARDIVE DYSKINESIA: myoclonoic jerks, tics, dystonia; usually orofacial region
- tx: stop med
Treatment of asymptomatic herpes zoster opthalmicus, even if patient is asymptomatic for pain or vision changes
Optho consult!
what should be monitored with Niacin use?
liver function tests
How to confirm diagnosis of Parkinson's
improvement with levodopa
What are the risk factors for Postpartum Urinary Retention (PUR)?
- how is it treated?
- when is it expected to be resolved?
- primiparous
- prolonged first and second stage of labor
- instrumented vaginal deliveries
- c-section after unsuccessful vaginal delivery

- intermittent self catherization

- 2-6 days after delivery, up to weeks afterwards
Common cause of wheezing associated with persistent spit up in the pediatric population
Minimum size requirement for FNA of incidental thyroid nodule
1 cm
- monitor all other nodules. no need to bx them, too small
In primary hyperparathyroidism, what will PTH levels be like?
High or NORMAL
- they should be low if it is any other cause of hyperparathyroidism. If they are normal, then it is still primary hyperPTH.
Define Horner's Syndrome
- what is it associated with?
- what type of work-up would you do
Horner's Syndrome: unilateral ptosis, myosis, anhydrosis
- associated with Pancoast superior sulcus tumor of the lungs
- work up with CXR
#1 cause of hearing loss in newborns
genetic disorders
- calcium channel blockers recommended for a-fib control
- beta blockers recommended for a-fib control
CCB: veparamil, diltiazem
BB: metoprolol, atenolol, sotalol
#1 side effect of testosterone supplementation for hypogonadism
- how can this be monitored?
- q6 months for the first 18 months --> annually
- DC if hct rises > 50%
Most specific test for rheumatoid arthritis.
anti-citrullinated antibody
Initial recommended therapy for all forms of urinary incontinence
Pelvic floor muscles and bladder training with physical therapy
- If above fails, then start pharmacological therapy individualized for each type of incontinence
What are the most common causes of neurological muscle weakness in young females?
- Myasthenia gravis
- MS
- Guillian Barre
Myasthenia Gravis
- pathophys
- clinical presentation & systems involvement
- daily progression of symtpoms
PATHOPHYS: skeletal muscle weakness secondary antibodies against cholinergic synapses

SX: skeletal muscle weakness
- face/eyes #1: ptosis & diplopia
- neck: difficulty swallowing, impaired speech, neck weakness
- lungs: shortness of breath
- body: weakness in arms, hands, legs, shoulders, feet.

- worsen during the day and improve at night with rest
Most common cause of death in the first 30 days after bariatric surgery
#1: pulmonary embolism
- anostomotic leaks
Best method to determine intrabadominal bleeding following truma in an:
- unstable patient
- stable patient
- peritoneal lavage immediately --> immediate laparotomy if positive

- CT of the abdomen
Work-up for fever of unknown origin in a healthy appearing child of the following age:
- 0-29 days
- 1-3 months
- 3-36 months
0-29 DAYS
- full sepsis work-up inpatient

- CBC + UA
- f/u in 24 hours
- other studies based on symptoms

- < 39 C/102 F: follow up in 24 hours, no workup
- > 102 F: CBC + UA + based on history
Macular degeneration in the elderly is commonly associated with what chronic condition?
- also occurs with cigarette smoking
Which of the pap results have the highest rates of malignancy?
What is true about the FDA and Canadian drugs?
Most drugs from Canada are approved by the FDA and made from the same manufacture
What test should be ordered if there is high concern for vitamin B12 deficiency and levels are normal?
methylmalonic acid
- levels will be high as it is a precursors for vitamin B12 synthesis
Protocol for "fight bite" (hand injury after punching a person on the face and hitting their teeth)
- xrays to rule out a fracture (whether or not there is concern for it)
- Augmenting
- update tetanus booster status
Give the etiology for each of the following cause of pain in RUNNERS:
1. groin pain with limited hip flexion and internal rotation
2. pain over the lateral femoral epicondyle
3. pain in the anterior pelvic area and tenderness over the pubic symphysis
1. stress fracture of the femoral neck
2. IT band syndrome
3. Osteitis pubis
For PREBUBERTAL LABIAL ADHESIONS, describe the following:
- clinical presentation
- findings on physical exam
- etiology
- tx
- recurrent urinary tract infections, vaginitis, "pulling sensation", difficulty voiding

- fusion of the labia leading to closing of the introitus

- idiopathic

- estrogen cream BID at the midline point of the fusion
- gestational age where secondary causes are more likely
- initial recommended tx
- secondary tx
- consider secondary causes after 9 WEEKS
- tx: 1st) Unisom, vitamin B6, Zofran
2nd) add Reglan
Which supplement can aid in increased PO iron absorption?
vitamin C - an acid
- an acidic environment is required for proper iron absorption
#1 cause of seizures in the elderly
What is another name for urge incontinence?
detrusor instability
* not detrusor hypotonia = neurogenic bladder
Treatment for full term HELLP Syndrome
delivery via SVD induction if cervix is favorable
- c-section otherwise
* no need to deliver via c-section first, can attempt vaginal if baby is stable
What is the only fluoroquinolone that should not be used in UTIs?
- why?
- it is not renally excreted and will not concentrate well in the urine
What is the most common adverse effect in the hospital?
drug-related events
Peak age for RSV bronchiolitis
2-7 months
Which of the SSRIs has the highest side effect if abruptly stopped?

- must wean off all SSRIs!
What are the recommendations for UTI work-up in children?
VCUG and Renal ultrasound in the following:
- any child < 5 yo with culture proven UTI
- any child with a febrile UTI
- school-aged girls with 2+ UTIs
- any boy with a UTI
Prevention of contrast-dye nephropathy, besides IVF
Initial recommended test for hearing loss
Where do most compression fractures occur?
mid thoracic, T8-T12
Recommended tx for compression fracture in regards to:
- mobility
- pain control
- surgery
- Mobility: short period of immobility (up to 1 week)
- Pain: opiates & intranasal calcitonin spray
- Surgery: kyphoplasty once conservative tx fails
Recommended work-up for compression fracture concern
plain film of the entire spine
- if concern still high and unclear, get CT
Fat-pad atrophy vs. plantar fasciitis presenting symptoms
- both cause heel pain
- Plantar fasciitis: pain worse in the morning, better as day progresses
- Fat-pad atrophy: pain better in the morning, worse as the day progresses
Treatment recommendation for head lice in a child
Malathion (Ovide)
- more effective than Lindane
Asthma classification based on frequency of symptoms & FEV1
- night time sx < 1x/month
- day sx < 2x/week
- FEV 1 > 80%

- night time sx < 2x/month
- day time sx 2-6 days / week
- FEV1 > 80%

- night time sx > 1x/week but not nightly
- daytime sx daily
- FEV1 60-80%

- nighttime sx nightly
- daytime sx throughout entire day
- FEV1 < 60%