Miscellaneous
Which of the following population groups has the highest prevalence of impaired medical decision-making capacity?
A. persons with learning disabilities
B. inpatients on medical wards
C. healthy older adults
D. patients with alzheimer disease
A. persons with learning disabilities
In adult patients not confirmed to have asthma with either baseline spirometry or serial bronchial challenge testing, what fraction can be safely weaned off their daily asthma medication?
A. 1/2
B. 1/3
C. 1/4
D. 3/4
One-third of adults with diagnosed asthma can be weaned off all asthma meds
True or False - synthetic cannabinoids are compounds with cannabinoid-like action but a different chemical structure than marijunana-derived cannabinoids
true
Participation in this type of exercise may help reduce labor pain, but reported effects vary from modest to moderate (strength of recommendation: B)
A. Yoga
B. Pilates
C. Tai chi
D. Walking
A. Yoga
What percentage of appendectomies result in removal of a normal appendix?
A. <5%
B. <10%
C. <15%
D. <20%
B. <10%
Which of the following statements about hepatitis B infection is correct?
A. persons diagnosed with HBV infection should be monitored for hepatocellular carcinoma
B. Screening for HBV is warranted for all international travelers
C. Adverse effects from HBV vaccination are common
D. Pregnant women require screening for HBV infection only if they are at increased risk
A. persons diagnosed with HBV infection should be monitored for hepatocellular carcinoma
In infants from whom a clean-catch urine sample is needed, do not attempt catheterization without at least considering
A. The fast splash method
B. The slow flow method
C. The quick wee method
D. The speedy pee method
C. The Quick-wee method (gentle cutaneous suprapubic stimulation using gauze soaked in refrigerated saline)
For how long is cocaine typically detectable in the urine?
A. less than 24 hrs
B. Two to three days
C. four to seven days
D. one to two weeks
B. two to three days
What type of skin closure after cesarean delivery has better cosmesis: staples or subcuticular sutures?
A. Staples
B. Subcuticular sutures
C. No difference between the two
C. No difference between the two
Antibiotic treatment as sole therapy for adults with appendicitis resulted in decreased complications, less sick leave or disability and less need for pain medication compared to appendectomy. However ___% of patients required appendectomy within one year.
A. 40%
B. 50%
C. 60%
A. 40%
When delivering bad or life-altering news, the "N" in the NURSE mnemonic for expressing empathy stands for:
A. Nursing support
B. Numbers
C. Networking
D. Naming
Naming - "it sounds like you are worried about..."
In patients with stable angina and severe coronary artery disease, PCI plus optimal medical treatment has what effect on exercise tolerance compared to sham PCI plus optimal medical treatment?
A. Improves exercise tolerance or angina
B. Does not improve exercise tolerance or angina
C. No difference in exercise tolerance or angina
In patients with stable angina and severe coronary artery disease, PCI plus optimal medical treatment does not improve exercise tolerance or angina compared to sham PCI plus optimal medical treatment
**DAILY DOUBLE**
The use of what medication should be avoided in patients with cocaine intoxication and non-ST segment elevation due to acute coronary syndrome
unopposed beta blockers
*of note, patients with only a recent hx of cocaine use but not exhibiting signs of acute intoxication should be treated in the same manner as pts without cocaine use and acute non-ST-segment elevation MI
What is one major difference between skin closure after cesarean with staples vs subcuticular sutures?
A. At 6-8 wks postpartum scar scores were worse for the staples group
B. The subcuticular sutures group was more likely to have allergic reactions to the suture material
C. There are no major differences between closure with staples vs sutures
D. The risk of wound complications is doubled with staples
D. The risk of wound complications is doubled with staples (infection, separation, hematoma, seroma)(SOR: A, based on meta-analyses of RTCs)
The signs and symptoms that best rule in appendicitis in adults are (choose all that apply):
A. RLQ pain
B. Abdominal rigidity
C. radiation of periumbilical pain to RLQ
D. Nausea
A,B,C
Lifitegrast ophthalmic solution 5% (Xiidra) for dry eye disease is an inhibitor of ______ and has been shown to reduce immune-mediated inflammation
lymphocyte function-associated antigen 1 (LFA-1)
The use of statins for men with an LDL cholesterol level of at least _____ mg/dL, regardless of calculated risk, is associated with a clinically and statistically significant reduction in CV events and probably cardiovascular and all-cause mortality
190 mg/dL
Cocaine use contributes to ___% of nonfatal myocardial infarctions in patients younger than 45 years
25%
Physical therapy started within 24 hours of acute low back pain
A. Provides significant improvements in pain at one week (8 points out of 11)
B. Provides only minimal improvements in pain at one week (1 point out of 11)
C. Provides no improvement in pain
B. Provides only minimal improvements in pain at one week (1 point out of 11) (SOR: B, based on single RCT)
These benefits were lost at one, three and six months and there were no other differences in satisfaction, pain, activity limitations, or mental or physical health
This clinical decision tool is the best-studied one for adults and children
A. appendicitis inflammatory response score
B. The pediatric appendicitis score
C. The alvarado score
D. The Monterey assessment score
C. The alvarado score
eight-item, 10-point tool that has been validated against the pediatric appendicitis score for use in children
High risk score (>/= 7)has 87% probability of appendicitis for adults and 67% for children
When counseling adults, adolescents and children about skin cancer prevention, which sun-protective behaviors should be routinely discussed?
A. Use of broad-spectrum sunscreen
B. self-examination of skin
C. wearing hats, sunglasses or sun-protective clothing
D. Avoiding tanning beds
B. Self-examination of skin
The USPTF found insufficient evidence regarding the benefits of counseling adults about skin self-examination to prevent skin cancer.
In patients with uncomplicated low back pain of less than two weeks duration, adding this medication to Naproxen 500mg twice daily did not further reduce pain
Diazepam (Diazepam adds little to NSAID treatment for acute low back pain)
MDMA causes a 10-fold greater release of of this neurotransmitter compared to methamphetamine, which induces intense mood effects. As a result, this syndrome can be a possible consequence of MDMA toxicity.
Serotonin syndrome
Based on a 2010 RCT of 148 patients with acute nonspecific low back pain, what effect did first-line care (stay active, use acetaminophen, reassurance) plus physical therapy initiated within 48 hours have compared to first-line care alone?
A. decrease posttreatment health care utilization
B. decrease disability scores
C. Increase mental health scores
D. Decrease pain scores
A. decrease posttreatment health care utilization (SOR: B, based on single RCT)
In a study of 375 children, risk factors for appendiceal perforation included a mean appendix diameter of _____ mm or more
11mm or more