PNS Entrapment and Injury to UE
Asthma
Initiating Hormonal Contraception
Topical Corticosteroids
Radial and Ulnar Fx
Pain Management in Labor
Random good stuff
USPSTF
100
What is most common entrapment neuropathy ?
Carpel Tunnel
100
Name 4 DDx for asthma
Bronchiectasis
Cardiac Disease
COPD
Cough induced by ACEi
Deconditioning
GERD
Obesity
Postnasal drip/allergies
Tracheobroncomalacia
100
True or False
OCPs should be started on first day of period
False
Old approach, quick start approach advocates that BC be started immediately upon request. If pt has had unprotected intercourse since last period urine preg should be obtained, cautioned on possibility of early preg not detectable, however OCPs will not cause harm. If unprotected intercourse in past 5 days should be offered emergency contraception.
100
True or False
Ointments are more efficacious then other formulations
False
Data show all formulations equally effective, choice should be based on area (i.e. foam good for scalp 2/2 hair) and insurance
100
What type of case/splint should be placed and for how long for a distal radius Fx?
Short arm cast
3-6wks
100
True or False
Patients management is most predictive factor for maternal satisfaction with childbirth.
False
Sense of empowerment and control
100
In patients with an upper GI bleed and hemodynamic instability, upper scope should be performed after fluid resuscitation and stabilization and within:
A)2 hours
B)6 hours
C)12 hours
D)24 hours
D) 24 hours
200
What are treatment modalities for nerve injury?
Minimal evidence for anything other then carpel tunnel. PT, yoga, and acupuncture may be helpful. Surgical decompression.
200
Name 4 significant co-morbid conditions affecting asthma
GERD
Rhinosinusitis/allergies
OSA
Immunoglobulin deficiency
Cardiac disease
Depression/anxiety
200
True or False
Lactation is up to 98% effective as contraception
True, but only up to 6mo and if child receives at least 90% of calories from breast milk
200
Name 3 conditions in which high quality data supports treatment with topical corticosteroids
Atopic dermatitis, psoriasis, lichen sclerosus, alopecia areata, vitiligo, bullous pemphigoid, phimosis, and aphthous ulcers
200
What type of splint/cast should be placed for radial head Fx?
Posterior Arm splint
200
True or False
Epidural can cause maternal fever
True, up to 30% of patients will have increase in temp with empidural
200
In treatment for refractory plantar fasciitis, PRP injection has what benefit compared to corticosteroid injection?
Improved longer term pain relief, no change in function.
200
These types of polyps, seen on colonoscopy, generally do not increase risk of cancer
What are hyperplastic polyps.
300
What is the axillary nerve cervical root innervation?
What muscles does it innervate?
How does damage to it present clinically?
C5
Deltoid and teres minor
Lateral shoulder paresthesia, shoulder weakness in all planes, overhead activity difficult
300
True or False?
Adding LAMA to patients already receiving LABA plus and inhaled corticosteroid improves asthma control.
False
Adding LAMA to inhaled corticosteroid therapy is superior to placebo, not superior to LABA combined with inhaled corticosteroid, and there is NO benefit of triple therapy.
300
Name 3 types of emergency contraception
- levonorgestrel (Plan B)
- ulipritsal (Ella)
- Copper IUD
300
How many finger tip applications is the front of the trunk?
300
How do combined mid-shaft Fx occur and why are they concerning?
High force like, high impact sports or MVA
Common to have neurovascular bundle damage
300
What percentage of patient become chronic opiod users after delivery?
2%
Approximately 1/3 of vaginal deliveries are d/c with opioids, 2/3 of c/s
300
Men and women in this range should be vaccinated with the HPV series
Up to 26 years old (usually starting between 9-11 yrs). Shared decision making should be used for people 27-45 years old.
300
What is the recommended intervention by USPSTF for adults >18 with increased risk of CVD
Provide behavioral counseling to promote a healthy diet and physical activity
This recommendation does not apply to adults with other known modifiable cardiovascular risk factors such as abnormal blood glucose levels, obesity, and smoking; these populations are incorporated in other USPSTF recommendations.
400
Describe Cyclists palsy, including nerve involved, where it is compressed and clinical presentation
Ulnar nerve compressed at wrist
Atrophy of intrinsic hand mm, decreased grip strenght, pain, paresthesia, numbness or hand, positive froment sign
400
Which immune cells drive type 2 and non-type 2 asthma?
Type 2- eosinophils (associated with allergies)
Non-type 2- neutrophils (associated with obesity and smoking)
400
Name 5 absolute contraindications to combined OCPs
Active CA, postpartum, migraine with aura, BP > 160/100 (although caution with any HTN), ischemic heart disease, more then 1 risk factor (weight, smoking, HTN, age etc...), cirrhosis, active hepatitis, hx of stroke or DVT, antiphospholipid antibodies,
400
Name 3 Adverse Effects of topical corticost
400
What kind of fracture is this? Who is it usually seen in? What kind of splint/cast and for how long?
Buckle (compression), kids, short arm, 3wks
400
Name 3 non-pharmacologic interventions that have been shown to decrease pain
accupuncuture (limited data), trained labor support, i.e. doula (even shown to decrease rates for assisted vaginal deliveries and c/s), hypnosis, maternal position (upright), sterile water injection?, water immersion
400
Serum lactate elevation and clearance may not be as reliable for severity of sepsis in patients with this general disease?
Patients with Hepatic Disease
(Can cause abnormal elevations and low clearance)
400
How often should a 10 yr old obese male with FHx of HTN and HLD be screened for HTN?
A. They should monitor his blood pressure at home.
B. Their son should be screened for high blood pressure at least annually.
C. No screening is needed at his age.
D. There is not enough information to assess the harms and benefits of screening for high blood pressure in children.
E. There are more concerns about secondary hypertension at his age, which requires additional tes
E
The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents who are asymptomatic and are not known to have hypertension.1 There is adequate evidence about the longitudinal association between high blood pressure in children and adolescents and high blood pressure and other intermediate outcomes in adults. However, there is inadequate evidence on the effectiveness of interventions (pharmacologic, lifestyle, or combination) for the treatment of high blood pressure in children and adolescents to demonstrate reduced blood pressure or adverse health outcomes or improved intermediate outcomes (e.g., left ventricular hypertrophy).2 Secondary hypertension is a rare condition in older children; children younger than six years are more likely to have a secondary cause. There is also inadequate evidence to assess the potential harms of screening and treatment in children and adolescents.
500
What is criteria for type 2 asthma?
At least one of the following:
blood eosinphilia (>150)
sputum eosinophilia (>2%)
Ferrous nitrous oxide (>20 parts per billion)
Need for maintenance oral steroid
500
Name one low, medium and high potency topical steroid.
500
What are indications for referral to ortho for distal radial Fx?
Abnormal radial inclination, radial length, or volvar tilt are abnormal?
500
Name 2 risks/side effects of nitrous oxide
Increased N/V, drowsiness, and contributes to greenhouse gas emissions.
500
How should Eczema herpeticum be evaluated and treated?
Dx should be clinical with immediate Tx, however, Polymerase chain reaction testing, culture, or Tzanck smear can be used to confrim
Tx with acyclovir, consider prophylactic abx as superimposed bacterial infection common, hospitalization for severe disease and/or immunocompromised pt
