Birth Control
USPSTF
Inpatient or Out
Furries
Dermatology
200
3 part question
1. I missed yesterday's COC pill, what should I do?
2. I missed 2 or more COC pills in a row, what should I do?
3. I missed 1 or more POP, what should I do?
1. Take 2 pills today, then continue like normal until the pack is complete. No need for condoms.
2. Take 2 pills today, then continue the pack until placebo week. Skip the placebo, and start a new pack instead. Use a condom until 7 days of coverage.
3. Take it right away, use a condom for the next week.
200
What age group of women get Q3Y PAP w/ cytology alone to screen for cervical cancer?
21-65
The key is "cytology alone"
21-24-27-30-33-36-39-42-45-48-51-54-57-60-63-65 (That's 16 pap smears!)
200
56 year old male has positive delta troponins, but no EKG changes, or chest pain.
Would you admit as inpatient or observation?
Classic cardiac observation patient.
If continues to uptrend, and needs catheterization, then the observation can be converted to an inpatient admission, and new H/P written.
but it served it's purpose, and helped to determine if further treatment was warranted or not.
200
Despite his sassy pose, this puppy dares you to name his breed.
What is english bulldog.
200
This condition, which worsens with cold weather, is classically treated with what agent?
Raynaud's phenomenon.
CCB: Amlodipine, Verapamil (if headaches are also present)
400
a 30 year old well controlled diabetic woman is considering starting OCP. What would be a reasonable choice?
Generally it is thought that estrogen can raise blood sugar, so choosing the lowest effective/tolerated dose necessary is the rule.
Option 1: Progestin Only: Norethindrone
Option 2: Very low dose combined: Lo-estrin
Option 3: consider non-hormonal contraception (CopperT), or Progestin only device (Nexplanon, Mirena)
400
What age group qualifies for Q5Y PAP, and under what circumstances?
Women aged 30-65.
Need either: HR HPV testing, OR Cytology and HR HPV (aka Co-Testing)
21-24-27-30=35=40=45=50=55=60=65
(11 papanicolau exams)
400
43 year old male presents with 2 days intense abdominal pain, dehydration, and intolerance to food or drink after being stung by a scorpion over the weekend. His abdomen looks like this:
What is the name of the sign, how do you treat, and is this an observation or inpatient level admission?
Cullen's sign
NPO, Agressive IV fluids, IV pain control, probably lidocain drip.
I would do inpatient since he is probably going to take at least 48 hours to resolve the pain and advance the diet, if not longer.
But aggressive IV fluids is KEY to him doing well.
1 in 5 cases of pancreatitis can be so severe they progress to multisystem organ failure.
400
This unit of measure separates ponies from horses
What are hands?
Specifically, according to the american equine society guidelines, a horse is over 14.2 hands, and a pony is less than 14.2 hands when measured at the withers.
400
Your father in law calls you after clinic because his foot has been hurting for the past 2 days, and he hasn't been able to work or sleep.
You ask some questions, and the only thing that's changed is his PCP recently started him on a new blood pressure medicine. He was already on lisinopril, but the PCP noted that "one single med wasn't getting the job done." Your FIL can't remember the new drugs name.
What medicine do you think he started, and what would be a better choice given his current problem.
Probably HCTZ. Relatively contraindicated in gout because it increases uric acid resorption.
Amlodipine (or any CCB) would be a better choice now to add to his lisinopril to control BP.
600
This "phasic" birth control pill attempts to mimic natural fluctuations in hormones, and has been found to be best for regulating periods and controlling hormonal acne. Please provide your preferred drugs name.
What are tri-phasic combined oral contraceptives.
Tri-cycline, tri-sprintec, etc
600
as of 2021, all sexually active women 24 and younger should be screened for...
Gonorrhea/Chlamydia
Also screen 25 and older if high risk for infection.
600
65 year old male who received TNK in the ER post stroke, is now BP is trending up, and RR is trending down slightly.
What do you do?
Order stat repeat CT head.
If hemorrhage Identified, need TNK reversal w/ cryo and TXA, re-consult Neuro, and transfer to Als for neurosurgery.
600
Raised to guard sheep from wolfs, this traditional Hungarian breed is often compared to a household cleaning instrument.
What is a Komondor
600
Not long after a heating pad was placed, this patient developed this characteristic rash:
What is erythema ab igne
800
This "phasic" birth control pill is especially good at managing periods because the woman can skip her placebo week, and just start a new pack to avoid any bleeding. Please provide your preferred drugs name.
What are mono-phasic combined oral contraceptives.
Yasmin, Loestrin, sprintec, etc
800
All adults aged 18-79 should be screened for...
Hepatitis C Virus.
Cat B, 2020.
800
A pleasant 67 year old male presents acutely short of breath, with orthopnea, DOE, JVD, and bilateral lower extremity swelling after his PCP wasn't able to see him in clinic on friday to refill his lasix.
He takes metoprolol tartrate, lasix, and lisinopril normally.
What does he need before discharging?
Outpatient admission
Lasix
Echo
EKG
Optimize his CHF meds.
Metop tartrate is not indicated for CHF.
Needs Metop Succinate, Carvedilol, or Bisoprolol
800
Named for the unique fur growth on this breeds backside, they were bred extensively in english ruled pre-apartheid Zimbabwe.
What is Rhodesian Ridgeback
800
A mother who recently immigrated to the United States from Mexico brings her 4½-year-old son to your clinic for his pre-kindergarten examination. The child’s examination is normal except for a hemangioma located on his left arm. His mother says that the lesion appeared at about 4 weeks of age, continued to grow until he was about 5 months of age, and then began to flatten, shrink, and fade. She is concerned because it has not improved in the past 18 months. When you examine the lesion more closely you note telangiectasia, fibrofatty tissue, dyspigmentation, and scarring where involution has occurred.
What is the diagnosis, and treatment?
Referral for surgical excision:
Infantile hemangiomas usually appear by 4 weeks of age and stop growing by 5 months of age. As many as 70% leave residual skin changes, including telangiectasia, fibrofatty tissue, redundant skin, atrophy, dyspigmentation, and scarring. Systemic corticosteroids were the mainstay of treatment for hemangiomas during infancy until 2008, when the FDA approved oral propranolol for this indication. Intralesional corticosteroids can be effective for small, bulky, well localized lesions in infants. Laser therapy can also be used to treat early lesions or residual telangiectasia. Once involution is complete, however, as is the case with this child, elective surgical excision is the treatment of choice, producing better outcomes.
1000
A obese, hypertensive woman wants to get her mirena pulled out, and started on OCP. What do you choose?
You can't choose a combined OCP (no estrogen).
So must go with Norethindrone (minipill)
1000
As of August 2021, all adults, aged 35-70, who are overweight or obese, should be screened for what?
type 2 diabetes.
Either A1C or glucose challenge
BMI 25-29.9 = Overwieght
BMI 30 and up = Obese.
1000
55 year old male presents acutely dyspnic, orthopnic, with JVD, and progressive fatigue over the last several months. His current medications include only occasional Lasix.
He has an elevated BNP, and is found to have an EF of 25%.
What medicines should be considered to increase his survival prior to establishing with cardiology?
Prolongation of patient survival has been documented with beta blocker, ACE inhibitors (similar with single agent ARB), ARNI, dapagliflozin (an SGLT2 inhibitor), hydralazine plus nitrate, and MRA. Limited evidence of survival benefit is available for diuretic therapy.
-Entresto (ARB/ARNI)
-Farxiga
-BiDil
-Eplerenone
1000
Hailing from Turkmenistan, this 3000 year old breeds name means "Golden Horse"
What is Akal-Teke?
1000
This painless swollen nodule on the eyelid results from an obstruction of the meibomium gland, and results in a sterile lipogranulomatous build up.
What is Chalazion.
As compared to a swollen, red, hot, PAINFUL, swelling of the glands known as a stye or hordeolum.
