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100

Name 2 absolute contraindications to exercise stress testing?

Severe CHF, significant aortic stenosis, myocarditis, unstable angina, acute MI within 2 days, recent PE, BP >200/120

100

late decelerations on FHT represent

placental insufficiency 

100

McMurray test most commonly tests for ?

meniscal tears

100

CURB - 65 criteria

Confusion

Uremia (BUN >19)

Respiratory rate (RR>30)

BP (SBP <90 or DBP <60)

Age >65

100

What year was family medicine formally recognized as a speciality

Feb 1969

200

22yoF with h/o palpitations, currently in office denies dizziness or palpitations. EKG in office shows the below. Otherwise healthy and no medications. No FHx. Next step in management?


No treatment unless symptomatic. A betablocker like metoprolol may help to reduce symptomatic PACs


200

Who gets an endometrial biopsy ?

EMT >4mm postmenopausal (or >45yo)

If >35yo with risk factors for endometrial hyperplasia (obesity, diabetes). 

200

Tearing this ligament causes a positive Lachman's test

ACL

200

HIV Prophylaxis: CD4 less than 50-100/mm3. 

Name the Bug and Drug

Mycobacterium avium complex (MAC), weekly azithromycin 

- DC when CD4 is >100 for more than 3 months 

200

Dr. Halle Dillon, most famously known to be what?

The first FEMALE physician in Alabama. She was also the first African American. 

- Board Certified in Montgomery in 1891. worked at Tuskegee as a Resident physician with Booker T Washington. 

- died 1901 of dysentery and childbirth at the age of 37

300

300

What OB complication is NOT negatively associated with cigarette smoking?

IUGR, low birth weight, PreE, placental abruption

PreE

300

45yoF house cleaner with left shoulder pain. Exam shows pain and relative weakness when pushing toward the midline against resistance while the shoulder is adducted and elbow is bent to 90 degrees. With elbow at 90 deg she is unable to keep left hand away from her body when positioning hand behind her back.

Name tendon most consistent with this injury. 

Subscapularis

weakness with internal rotation

- positive internal lag test (inability to keep hand away from her body when placed behind her back)

300

10yoM with 8mm induration after 2 days tuberculin skin test. Shares bedroom with 18yo brother who was diagnosed with TB. No PE or Sxs to suggest active infection. CXR is normal. 

Next step?

A. monitor with annual TB skin test

B. Observe and repeat test in 3 weeks

C. Rifampin daily for 4 months

D. Isoniazid daily for 9 months

E. Once-weekly isoniazid and rifampin for 3 months

Positive test in exposed individuals 5mm. (also XR evidence prior infxn, HIV or immune suppressed) 

Kids 2-11yo, tx isoniazid 10-20mg/kg daily OR 20-40mg/kg twice weekly for 9 months. Shorter 6 months for adults is not recommended in pediatrics. Not recommended to use rifampin alone or in combo with isoniazid in kids under 12yo. 

300

This compound, AKA folinic acid, can "rescue" a patient from methotrexate toxicity. 

Leucovorin

400

What is Heyde syndrome?

triad of aortic stenosis, GI bleeding and acquired von willebrand syndrome

Commonly seen in the elderly; due to increased circulatory shear forces ---> cleavage of large von Willebrand multimers. 

400

Which of the following bacterial infections are NOT generally associated with preterm labor? 

A. ureaplasma urealyticum

B. mycloplasma hominis

C. Gardnerella vaginalis

D. Bacteroides species

E. All are associated with preterm labor

E. all are associated with preterm labor

400

Name the injury:


Boxer fracture

- fracture of 5th metacarpal head 

Tx: closed reduction and ulnar gutter splint 

400

Previously treated c. difficile colitis with oral vancomycin 2 weeks prior presents with recurrent watery diarrhea for the past 3 days. Recurrent infection is confirmed. What is appropriate treatment?

Fidaxomicin 200mg BID for 10 days

If available, a prolonged tapered course of vancomycin could be used if a 10-day course was prescribed initially (weak recommendation, low quality of evidence). Vancomycin is only recommended for a first recurrent episode if metronidazole was used initially (weak recommendation, low quality of evidence).

400

Name all the features associated with CHARGE syndrome

coloboma, heart defects, atresia choanae (choanal atresia), growth retardation, and ear abnormalities. 

500

Name 3 out of 5 terrible T's of congenital cyanotic heart disease 

Tetralogy of Fallot, Transposition of great vessels, total anomalous venous return, tricuspid atresia, persistent truncus arteriosus

500

Who is this?


Elizabeth Blackwell

First woman to be granted an MD 

- attended Geneva Medical College in NY, co-founded New York Infirmary for Indigent Women and Children

500

Ottawa Ankle Rules (must name all 4)

1. Posterior edge or tip of lateral malleolus

2. Posterior edge or tip of medial malleolus

3. Base of 5th metatarsal

4. Navicular 

500

65yoM admitted for sepsis found to be growing bacterioides fragilis on 2/2 blood cultures. what is the likely source associated with this bug and what screening did he likely not receive? 

Colonoscopy; likely secondary to GI malignancy. 

Piperacillin/tazobactam, meropenem, and metronidazole have high susceptibility rates.

500

Name that Syndrome:

SGA infant with normal mental development. Large fontanels, triangular face (petite face with relatively large head), forehead nevus flammeus, Blue sclera, precocious sexual development, asymmetric arms and/or legs. 

BONUS 200 points if can name the abnormality in the gene

Russell-Silver Syndrome 

- gene: methylation abnormalities in IGF2

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