50 terms

2014 ABFM Practice Questions VI

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Which sleep disturbance in children occur during:
- the first half of the night
- the second half of the night
FIRST HALF (non-REM sleep)
- Nocturnal limb pain
- Sleepwalking
- Night terrors
- Confusion and arousal

SECOND HALF (REM)
- Nightmares
Choice of anti-psychotic for dementia in Parkinson's disease
- explain
Quetiapine (seroquel)
- it has less anti-dopaminergic properties than other atypical antipsychotics
Timing criteria for diagnosis of schizophrenia
Symptoms of disturbance for at least 6 months, with at least 1 month of positive symptoms during the 6 months
SSRI with least Cyt-P 450 inhibition (least drug-drug interaction)
celexa
- good choice for patient on multiple meds
Earliest presenting symptom in open-angle glaucoma
tunnel vision (loss of peripheral vision)
Outpatient treatment for dental abscess
- penicillin
- Clinda if allergic to PCN
Describe the lesion of keratoacanthoma
- describe nature of lesion
- has a CENTRAL PLUG in the middle
- will appear rapidly and may resolve spontaneously and rapdily
Xerosis vs. lichen simplex chronicus
Xerosis = excessive dry skin
Lichen Simplex Chronicus = pathology after persistent rash (a consequence of xerosis)
Main difference between Acne Neonatorum and Erythema Toxicum
- describe milia
ACNE NEONATORUM: open and closed comedones and pustules without erythema

ERYTHEMA TOXICUM NEONATORUM: open and closed comedones and pustules with erythema

MILIA: plugged keratin plugs without erythema
Risk factor for cutaneous leishmaniasis
- describe lesions
- Travel internationally, military
- 2 cm minimally tender lesions with central ulceration and crust
Ingrown toe nail tx
- lateral removal of affected side nail plate with lateral matricectomy
do not remove entire toenail
Recommendation for topical antibiotics post surgical wound
AGAINST it.
- topical pretoleum jelly only.
How does mild cognitive impairment defer from dementia
normal ADL
- only presence of objective evidence of memory decline
- in between normal and dementia
What is the most important criteria for joint damage in Gout?
uric acid levels
- must be below 6 to further prevent joint damage
Tetanus booster recommendations
- every 10 years for Tdap
- Tdap 5 years after Td booster
Describe recommended steroid dosing in patients with COPD exacerbation
5 day course of PO steroids, stop if patient is improving
- 5 days = 14 days, no further benefit
Spirometry values in restrictive lung disease
Decreased FVC and normal or increased FEV1/FVC ratio
Recommended ADHD therapy based on age of child
PRE-SCHOOL (4-5)
- 1st: behavior modification
- 2nd: meds (methylphenidate)

ELEMENTARY SCHOOL (6 and above)
- 1st: combo behavior mod + meds
Relationship between Amlodipine and H. pylori therapy
clarithromycin is a cyt P450 inhibitor
amlodipine is metabolized by cyt P450 system
- DC amlodipine in patients undergoing any cyt P450 inhibition therapy
Tx of lateral epicondylitis
- modify disease activity, conservative regimen
- NOTHING has been proven to help sx: 95% will improve spontaneously regardless of what you do
Physical exam distinction between Gout and Sesamoid Fracture during 1st MTP joint pain
GOUT
- tenderness, erythema and swelling
- pain with motion in all planes
- acute pain

FRACTURE
- tenderness, no erythema, swelling
- pain with dorsiflexion, no pain with plantarflexion
- gradual pain with increased activity
Finding that is concerning for Compartment Syndrome after trauma besides the classic "5 P's"
- pain that is out of proportion to the physical exam
- severe pain with passive stretching of the involved muscles
Etiology of chronic diarrhea associated with extraintestinal symtpms
Chrons
- most other causes of chronic diarrhea will not have systemic inflammatory symptoms
Recommended tx for osteoporosis in CKD patients
denosumab
- bisphosphonates contraindicated
Describe the types of strabismus and CN deficits with each one
Exotropia: CN III
Hypertropia: CN IV
Recommendation for augmentin tx in AOM
- recommendation for ear tube placement
- when patient has received another antibiotic therapy in the previous 30 days
- ear tube placement: 3 x in 6 months, 4 x in 1 year with 1 in 6 months
Prophylaxis for Lyme disease
single dose of doxy
- 14-day course only for acute tx
Best type of exercise program for the elderly that leads to improvement in overall function
resistance training
Target A1C in the elderly with complex medical problems
< 8.5%
Causes of low DLCO
- chronic PE (with normal spirometry)
- emphysema (with obstructive pattern spirometry)
- severe interstitial fibrosis (with restrictive pattern spirometry)
recommendations for lung CA screening with chest CT
adults 55-80 with 30-pack-year smoking history who currently or have smoked in the past 15 years
Conditions that require increased doses of warfarin for proper INR target
- hypothyroidism
- DM
- HLP
- visceral CA
- increased vitamin K intake
Tuberculosis screening test recommended for BCG-vaccinated patients
interferon-gamma
Most specific sign of heart failure
S3
Describe the Salter Harris Fractures
Penicillin + rash at any time during treatment
Possible allergy
- does not have to be in the initial course of the therapy
Only anti-hypertensive recommended during pregnancy
labetalol
- stop all other anti-hypertensives
Differential diagnosis for pytyriasis rosea rash
secondary syphilis
- rash is exactly the same minus herald patch
Ultimate dx of IBD
colonoscopy with biopsy
- regardless of timing
Describe CHA2DS2-VAS score
C: CHF
H: HTN
A: age > 75 (2 points)
D: DM
S: stroke (2 points)
V: vascular disease
A: age 65-74 (1 point)
S: sex = female (1 point)

* any point -> warfarin.
* 0 = aspirin
TTP vs. ITP
TTP: systemic symptoms
ITP: isolated thrombocytopenia with rash
Best tx for chronic Achilles tendinopathy
eccentric exercises
Red flags for CSF rinorrhea
- worse when changing from recumbent to standing position (worse in the morning)
Recommended tx for pediatric sinusitis
- first choice
- PCN allergy
DOFC
- amoxicillin

ALLERGY
- cephalosporin (risk of cross reaction is very low)
- HiB and Pneumococcus are resistant to other drugs
EKG abnormality that invalidates exercise ST
LBBB
Recommended oral steroid tx in severe poison ivy contact dermatitis
high dose with 14-day tape
Difference in between beta-hemolytic strep and Group A strep cellulitis
BETA HEMOLYTIC
- your typical cellulitis, normal growth rate

GROUP A STREP
- necrotizing fasciitis
- an emergency: rapid growing cellulitis in a toxic patient
- tx with broad spectrum antibiotics
HIV prophylaxis
- PCP
- Toxoplasma
- MAC
PCP: < 200 - bactrim
Toxoplasma: < 100 - bactrim
MAC: < 50 - azithromycin
DOFC for sx tx in all PCOS symptoms
OCP's
- add extra therapy based on specific titration of the symptoms (fertlity, insulin resistance, etc)
Greatest GBS risk factor in a GBS unknown patient
- delivery < 35 wga