Cardiovascular
a) sexual intercourse should not resume for at least 3 months
b) patients who have sustained an MI should not work for at least 4 months
c) patients who have sustained an MI gradually may increase activity during 6 to 8 weeks
d) no significant psychological distress regarding the MI has been shown to occur in the patient's spouse or significant other
e) all of the above
Patients who have sustained an MI gradually may increase activity during 6 to 8 weeks.
A 50-year-old right-handed female waitress with rheumatoid arthritis presents to your office complaining of pain in her right wrist. She tells you that the pain is 6/10, is worse at the end of the day after her shift and better when she doesn’t have to carry trays or dishes at work. Your physical exam shows tenderness to palpation at the radial styloid and pain that is exacerbated by grasping the thumb and abducting the hand toward the ulna. X-rays of the right wrist and hand are normal. What is the most likely diagnosis?
De Quervain’s disease is also called stenosing tenosynovitis of the abductor pollicus longus.
Associated with RA, and 6 times more common in women
An elderly patient with a known history of CHF develops an abnormal breathing pattern while asleep in her nursing home. This pattern consists of a repeated cycle of apnea followed by hyperpnea.
What is Cheyne-Stokes respiration/breathing
a) It is more common in women than men
b) antithyroid antibodies are found in the majority of individuals with this condition
c) symptoms of hyperthyroidism often precede symptoms of hypothyroidism
d) it is also known as chronic autoimmune thyroiditis
e) it is due to antibody-mediated destruction of circulating thyroid hormone.
The pathophysiology includes antibody and cell mediated destruction of the thyroid gland, not the thyroid hormone.
a) elevated HDL level
b) elevated triglyceride level
c) elevated LDL level
d) depressed HDL level
e) elevated total blood cholesterol value
Elevated LDL level
a. insidious onset
b. onset before age 40
c. morning stiffness
d. aggravation of pain with activity
e. pain for more than 3 months
improves with activity
a) CBC, BCx, oral Amoxicillin, follow up in 10-14 days
b) CBC, BCx, IV ceftriaxone, follow up in 24 hours
c) CBC, BCx, UA and UCx, CSF culture, IV ceftriaxone and admission to the hospital
d) CBC, UCx, Oral water, Acetaminophen, follow up in 12-24 hours
For febrile infants <3 months of age entire sepsis workup has to be done.
a) Sulfonylureas
b) Biguanides
c) DPP-4 inhibitors
d) Thiazolidinediones
Thiazolidinediones
( e.g. Rosiglitazone, Pioglitazone)
Mechanism of action: preserve beta cells from ongoing destruction.
SE: cause fluid retention (leading to heart failure); stimulate accumulation of adipose tissue
a) myocardial hypertrophy
b) valvular heart disease
c) cor pulmonale
d) low ejection fraction
e) wall motion abnormalities
Low ejection fraction (<40%)
A 58-year-old female presents to the hospital complaining of pain and stiffness in her thighs and shoulders that seems to be worse in the morning. Her only medication is sertraline, which was started three weeks ago for depression. Physical examination reveals 5/5 muscle strength throughout.
Polymyalgia Rhemuatica
(pain and stiffness in proximal muscles that is worse in the morning or after prolonged inactivity. Other symptoms include fever, weight loss, fatigue, and depression. PMR typically presents in patients over the age of 50 years of age. Patients do not have decreased muscle strength, which helps to distinguish it from other disorders presenting with proximal muscle weakness, such as polymyositis or dermatomyositis.)
FEV1/FVC
FEV1
Gold Staging System:
Stage I Mild: FEV1/FVC <0.70, FEV1 (postbronchodilator) >80% predicted
Stage II Moderate: FEV1/FVC <0.70, FEV1 (postbronchodilator) 59-79% predicated
Stage III Severe: FEV1/FVC <0.70, FEV1 (postbronchodilator) 39-49% predicated
Stage IV Very severe: FEV1/FVC <0.70, FEV1 <30% predicted or <50% predicated + respiratory failure
A 7-year-old boy presents with fever for 6 days. Examination reveals an uncomfortable child with erythema around the lips with cracking, bilateral conjunctivitis, a generalized rash and swelling of the hands. Labs show an elevated platelet count, CRP and ESR. Which therapy should be initiated?
A 57-year-old type 2 diabetic man presents to his primary care provider for his annual physical. He was diagnosed with diabetes seven years ago and has a history of alcohol abuse. His most recent hemoglobin A1C was 7.9 percent and fasting glucose of 156. He is not on any diabetic medications. He states that two years ago he had an episode of intense mid-abdominal pain that radiated to his back. He has had two more similar episodes. Ever since then, he has constant epigastric pain and has noticed loose, foul smelling stools that float in the toilet. Considering his glycemic control and past medical history, what class of anti-hyperglycemic agents is contraindicated for this patient?
Glucagon-like peptide-1 agonists
Risk of cholelithiasis, pancreatitis, pancreatic cancer
a) BB
b) CCB
c) Spironloactone
d) ACEi
e) Biventricular pacing
CCB : have shown no mortality benefit or decreased hospitalization benefit for CHF patients
A 43-year-old-female comes to clinic with complaints of a flare in her arthritis. The patient states that she has been taking an oral medication, the name of which she cannot recall, but did remember her rheumatologist stating that it is a safe drug and is also used to treat malaria. She takes one pill twice a day. Based on the description of the medication the patient was likely taking, what does the appropriate monitoring required for use of this medication include?
a. CMP (LFT's)
b. retinal exam
c. CBC
d. annual PPD
32 African American man with chronic cough, bilateral hilar lymphadenopathy and pulmonary infiltrates on chest radiograph. Restrictive lung pattern with non-caseating granuloma formation. What is first line treatment for this diagnosis
A 15 year old female presents to Akron Children's ED in moderate distress and a severe generalized rash. It is a maculopapular rash with confluent severe erythema associated with it. It is present on the palms, soles, dorsum of the hands, and extensor surfaces, trunk, abdomen, back, and there are some vesicular lesions present on the buccal mucosa. More than 50% of her skin is involved and Nikolsky's sign is positive. She is on Day 4 of Bactrim for a bad paranychial infection of the great toe. The diagnosis is ___
What is TEN? Toxic epidermal necrolysis
Stevens' Johnsons/Toxic epidermal necrolysis: peeling skin, mucosal lesions, could be macular, papular, vesicular or bullous in appearance. Common drugs: sulfa drugs, penicillin antibiotics, cefixime, barbiturates, lamotrigine, phenytoin, and trimethoprim. Common infections: Mycoplasma, EBV, CMV
SJS : <10% involvement of skin
TEN: >30% involvement of skin
a) Conn's
b) Cushing's
c) Addison's
d) Primary hyperparathyroidism
e) primary pituitary failure
Addison's = primary adrenocortical insufficiency.
Symptoms: weakness, weight loss, hyperpigmentation, hypotension
Labs: hyperkalemia, hyponatremia, increased BUN, hypercalcemia, increased plasma ACTH, and DECREASED SERUM CORTISOL LEVEL.
both short ACTH stimulation test and prolonged ACTH stimulation test yield no cortical response.
Ventricular septal defect (VSD) is the most common congenital heart defect, what condition is it most likely to be associated with?
a) Congenital rubella
b) Down's syndrome
c) Fetal alcohol syndrome
d) Maternal diabetes
What is FAS?
VSD is associated with fetal alcohol syndrome. PDA is associated with congenital rubella. ASD (ostium primum type) is associated with Down's syndrome. Transposition of the great vessels is associated with maternal diabetes.
A 7-year-old female presents to your office with her mother for the complaint of painful right knee that has been intermittent for over three months. She denies any trauma, previous injury and her past medical history is otherwise negative. Further questioning also reveals mild photophobia in the right eye as well as right eye soreness and occasional blurry vision which has also been noted to occur in the left eye. ANA is positive. Most likely diagnosis?
Juvenile idiopathic arthritis (JIA)
Give age range, criteria, modality of testing
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Give age range and frequency
The USPSTF recommends vision screening at least once in all children ages 3 to 5 years to detect amblyopia or its risk factors.
Give age range and criteria.
The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.