Show:
Musculoskeletal
Respiratory
Neurology
Current Events
Breast Cancer Awareness Month
100
A mother brings in her 2-month-old infant for a routine checkup. The baby is exclusively breastfed, and the mother has no concerns or questions. Which one of the following would you recommend at this time in addition to continued breastfeeding? (check one) A. Iron supplementation B. Vitamin D supplementation C. A multivitamin D. 8 oz of water daily E. 4 oz of cereal daily
What is Vitamin D supplementation. Supplementation with 200 IU/day of vitamin D is recommended beginning at 2 months of age and continuing until the child is consuming at least 500 mL/day of formula or milk containing vitamin D (SOR B)
100
In adults, which one of the following is the most likely cause of chronic, unilateral nasal obstruction? A. Nasal septal deviation B. Foreign body impaction C. Allergic rhinitis D. Adenoidal hypertrophy
What is A. nasal septal deviation.
100
A 65-year-old male has recently undergone coronary artery bypass graft (CABG) surgery. Generally, he has recovered well from his surgery. However, his cardiac surgeon referred him back to you because of symptoms suggestive of depression. Which one of the following is true in this situation? A. Patients with chronic cardiac symptoms prior to surgery are more likely to develop postoperative depression B. Postoperative depression increases the risk for subsequent cardiovascular events C. Treatment of postoperative depression with antidepressants decreases the rate of subsequent cardiovascular events D. Enrollment in a cardiac rehabilitation program often worsens depression
What is B. Postoperative depression increases the risk for subsequent cardiovascular events.
100
The incubation period for ebola may be up to ______ days?
What is 21 days. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. However, a large constitution of symptoms can be appreciated.
100
If you are screening your female patients for breast cancer yearly, starting at age 40, you are following the recommendations of the American Cancer Society or the United States Preventive Services Task Force?
What is the American Cancer Society.
200
A positive flexion abduction external rotation (FABER) test that elicits posterior pain indicates involvement of which joint? (check one) A. Sacroiliac B. Shoulder C. Ankle D. Wrist E. Knee
What is Sacroiliac. When the flexion abduction external rotation (FABER) test elicits pain posteriorly, it indicates sacroiliac involvement. Anterior pain indicates hip involvement.
200
A 70-year-old male sees you because of slowly increasing problems with COPD. He has had frequent exacerbations requiring emergency department visits. He currently uses a tiotropium (Spiriva) inhaler once a day, as well as an albuterol (Proventil) inhaler, 2 puffs 4 times a day as needed. An examination shows decreased breath sounds throughout, and an oxygen saturation of 92%. Spirometry shows he has severe COPD (stage III); his FEV1/FVC ratio is 65% of predicted and his FEV1 is 45% of predicted. The most reasonable change in treatment would be to add A. oxygen, 2 L/min while sleeping B. inhaled fluticasone (Flovent), 2 puffs twice daily C. oral low-dose prednisone daily D. oral theophylline (TheoDur, Uniphyl) twice daily
What is B. inhaled glucocorticoid. The addition of a corticosteroid inhaler for patients with severe disease has been found to significantly decrease the number of exacerbations, but has no effect on overall mortality. Side effects of oral candidiasis and easy bruising of the skin are increased. Continuous oxygen has been shown to improve overall mortality and endurance in patients with an oxygen saturation of 88% or less, but has not been shown to improve quality of life in those with mild hypoxemia or if used only at night. Oral prednisone has been shown to be effective when used to treat acute exacerbations, but when used on a chronic basis it is no more effective than corticosteroid inhalers.
200
An 87-year-old African-American female is admitted to your hospital with a hip fracture. She lives alone and has been self-sufficient. She has been able to drive, go to the grocery, and balance her own checkbook. She does well in the hospital until the second postoperative day, when she develops agitated behavior, tremor, and disorientation. She attempts to remove her Foley catheter repeatedly. She exhibits alternating periods of somnolence and agitation, and describes seeing things in the room that are not there. Which one of the following is the most likely diagnosis? A. Delirium B. Alzheimer’s disease C. Senile dementia D. Schizophrenia E. Psychosis
What is Delirium. Diagnostic criteria: A. Disturbance of consciousness (i.e., reduced clarity of awareness about the environment) with reduced ability to focus, sustain, or shift awareness. B. A change in cognition (e.g., memory deficit, disorientation, language disturbance) or development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. C. Development over a short period of time (usually hours to days) with a tendency to fluctuate during the course of a day. D. Evidence from the history, physical examination, or laboratory findings that indicates the disturbance is caused by direct physiologic consequences of a general medical condition.
200
A high-dose form the of the influenza vaccine is approved and recommended by the CDC for adults age __________.
What is 65 years and older?
200
Some indications for breast-ovarian cancer genetic counseling referral include: A. Women with breast cancer before age 50. B. Women with ovarian cancer diagnosed at any age. C. Women with a history of breast and ovarian cancer at any age. D. Individuals with bilateral breast cancer. E. All of the above.
What is all the above.
300
Osteoporotic bone loss can be caused or accelerated by prolonged use of which one of the following medications? A. Hydrochlorothiazide B. Phenytoin C. Raloxifene (Evista) D. Diazepam (Valium) E. Fluoxetine (Prozac)
What is Phenytoin. Anticonvulsants such as phenytoin increase the hepatic metabolism of vitamin D, thereby reducing intestinal calcium absorption. Other medications that adversely affect bone mineral density include glucocorticoids, cyclosporine, phenobarbital, and heparin. Thiazide diuretics reduce urinary calcium loss and are believed to preserve bone density with long-term use. Benzodiazepines and SSRIs have not been associated with increases in bone loss or in hip fractures. Raloxifene, a selective estrogen receptor modulator, is indicated for the prevention and treatment of osteoporosis in postmenopausal women.
300
A 24-year-old female with a past history of asthma presents to the emergency department with an asthma exacerbation. Treatment with an inhaled bronchodilator and ipratropium (Atrovent) does not lead to significant improvement, and she is admitted to the hospital for ongoing management. On examination she is afebrile, her respiratory rate is 24/min, her pulse rate is 92 beats/min, and oxygen saturation is 92% on room air. She has diffuse bilateral inspiratory and expiratory wheezes with mild intercostal retractions. Which one of the following should be considered in the acute management of this patient? A. Chest physical therapy B. Inhaled fluticasone/salmeterol (Advair) C. Oral azithromycin (Zithromax) D. Oral prednisone E. Oral theophylline
What is oral prednisone. Hospital management of acute exacerbations of asthma should include inhaled short-acting bronchodilators in all patients. Systemic corticosteroids are recommended for all patients admitted to the hospital. The efficacy of oral prednisone has been shown to be equivalent to that of intravenous methylprednisolone (SOR A). Oxygen should also be considered in most patients. Antibiotics are not recommended in the treatment of asthma exacerbations unless there is a comorbid infection. Inhaled ipratropium bromide is recommended for treatment in the emergency department, but not in the hospital (SOR A). Chest physical therapy and methylxanthines are not recommended in the treatment of acute asthma exacerbations.
300
A 33-year-old white female has a 12-year history of headache occurring 3–4 times per month, accompanied by nausea and vomiting. She takes over-the-counter analgesics, but relief is usually obtained only when she falls asleep. This is her first visit to you for this problem. You diagnose migraine without aura. Although the patient is willing to consider prescription drugs, she says that she would prefer “something that is natural and without side effects.” Which one of the following would be the best recommendation? A. Biofeedback B. Ma huang C. Oxygen D. Epley canalith respositioning maneuver E. Phototherapy
What is A. Biofeedback. Of the listed options covering the realm of complementary and alternative medicine, only biofeedback has been shown to have a therapeutic effect on migraine. Specifically, the modality that seeks to control physiologic response to skin temperature and skin conductance appears to be the most successful. It is best performed in a medical office by caring, supportive staff members under physician supervision. Oxygen is used to treat cluster headaches. The Epley maneuver is used for managing benign positional vertigo, and phototherapy is useful in seasonal affective disorder. Ma huang, a Chinese herb, has ephedrine properties but is not useful in treating migraine headaches.
300
The Montreal Cognitive Assessment (MoCA) may be the preferred assessment method over the Mini-Mental Status Examination in the appropriate clinical setting because it offers a better assessment of ___________ functioning.
What is executive function?
300
Invasive breast carcinomas consist of several histologic subtypes; the estimated percentages are from a contemporary population-based series of 135,157 women with breast cancer reported to the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute between 1992 and 2001. The most common form of breast cancer is: A. Infiltrating ductal B. Invasive lobular C. Ductal/lobular D. Mucinous (colloid) E. Tubular F. Medullary G. Papillary
What is A. Infiltrating ductal form of breast cancer represents 76% of all breast cancers.
400
A 2-week-old female is brought to the office for a well child visit. The physical examination is completely normal except for a clunking sensation and feeling of movement when adducting the hip and applying posterior pressure. Which one of the following would be the most appropriate next step? A. Referral for orthopedic consultation B. Reassurance that the problem resolves spontaneously in 90% of cases, and follow-up in 2 weeks C. Triple diapering and follow-up in 2 weeks D. A radiograph of the pelvis
What is a referral for orthopedic consultation. Studies show that these problems disappear by 1 week of age in 60% of cases, and by 2 months of age in 90% of cases. Triple diapering should not be used because it puts the hip joint in the wrong position and may aggravate the problem. Plain radiographs may be helpful after 4-6 months of age, but prior to that time the ossification centers are too immature to be seen. Because the condition can be difficult to diagnose, and can result in significant problems, the current recommendation is to treat all children with developmental dysplasia of the hip. Closed reduction and immobilization in a Pavlik harness, with ultrasonography of the hip to ensure proper positioning, is the treatment of choice until 6 months of age.
400
A male infant is delivered at 41 weeks gestation by spontaneous vaginal delivery. The amniotic fluid is meconium stained. Apgar scores are 7 at 1 minute and 7 at 5 minutes. The baby is noted to have respiratory distress from birth and is hypoxic by pulse oximetry. Respiration improves with supplemental oxygen, as does the hypoxia, but does not return to normal. Which one of the following would most likely be seen on a chest radiograph? A. A normal heart and lungs B. Fluid in the pulmonary fissures C. Homogeneous opaque infiltrates with air bronchograms D. Patchy atelectasis
What is patchy atelectasis. The chest radiograph of a child with meconium aspiration syndrome will show patchy atelectasis or consolidation. If the child has a normal chest film and respiratory distress, a noncardiopulmonary source should be considered (i.e., a neurologic or metabolic etiology). The chest film of a child with transient tachypnea of the newborn will show a wet silhouette around the heart, diffuse parenchymal infiltrates, or intralobar fluid accumulation. Homogeneous opaque infiltrates with air bronchograms on a chest radiograph are seen with hyaline membrane disease.
400
A 66-year-old white male is brought to your office for evaluation of progressive memory loss over the last several months. The problem seems to wax and wane significantly over the course of days and weeks. At times when he is more confused, he tends to have visual and auditory hallucinations that he is back fighting in Vietnam, thinking a ringing telephone is calling in fighter jets. He has also been falling occasionally. On physical examination, he has a resting tremor in his left leg, and rigidity of his upper body and face. A full medical workup, including standard blood work and a CT scan, shows no abnormalities that suggest delirium, stroke, or other primary etiologies. Which one of the following is the most likely diagnosis? A. Alzheimer’s disease B. Dementia with Lewy bodies C. Fronto-temporal dementia D. Multi-infarct dementia E. Pseudodementia
What is B. Lewy body dementia. The clinical presentation consists of parkinsonian symptoms (rigidity, tremor), fluctuating levels of alertness and cognitive abilities, and behavior sometimes mimicking acute delirium. Significant visual hallucinations are common, and delusions and auditory hallucinations are seen to a lesser degree.
400
_____________ is any medical or public health procedure used before exposure to the disease causing agent. Its purpose is to prevent, rather than treat or cure a disease.
What is pre-exposure prophylaxis?
400
The most specific mammographic feature of malignancy is a spiculated soft tissue mass; nearly 90 percent of these lesions represent invasive cancer
What is a spiculated soft tissue mass. Nearly 90% of these lesions represent invasive cancer. Approximately one-third of noncalcified cancers appear as spiculated masses, 25 percent as irregularly outlined masses, 25 percent as less specific round, oval or lobulated masses, less than 10 percent as well-defined round, oval, or lobulated masses, and 5 percent as areas of architectural distortion of dense tissue without an obvious mass. The other general category of mammographic findings suggestive of a breast cancer is clustered micro calcifications.
500
A 21-year-old white female presents to the emergency department with a history consistent with a lateral ankle sprain that occurred 2 hours ago while she was playing softball. She complains of pain over the distal anterior talofibular ligament, but is able to bear weight. There is mild swelling, mild black and blue discoloration, and moderate tenderness to palpation over the insertion of the anterior talofibular ligament, but the malleoli are nontender to palpation. Which one of the following statements is true regarding the management of this case? (check one) A. Anteroposterior, lateral, and 30 degrees internal oblique (mortise view) radiographs should be done to rule out fracture B. Stress radiographs will be needed to rule out a major partial or complete ligamentous tear C. The patient should use crutches and avoid weight bearing for 10–14 days D. Early range-of-motion exercises should be initiated to maintain flexibility E. For best results, functional rehabilitation should begin within the first 24 hours after injury
What is Early range-of-motion exercises should be initiated to maintain flexibility. The Ottawa ankle rules were developed to determine when radiographs are needed for ankle sprains. In summary, ankle radiographs should be done if the patient has pain at the medial or lateral malleolus and either bone tenderness at the back edge or tip of the lateral or medial malleolus, or an inability to bear weight immediately after the injury or in the emergency department, or both. If the patient complains of midfoot pain and/or bone tenderness at the base of the fifth metatarsal or navicular, or an inability to bear weight, radiographs should be ordered.
500
Which one of the following unimmunized patients should receive two doses of influenza vaccine? A. A 5-year-old with asthma B. A 10-year-old with cystic fibrosis C. A 15-year-old with sickle cell anemia D. A 30-year-old with HIV infection E. A 65-year-old with bullous emphysema
What is A. Two doses of influenza vaccine are recommended for children under the age of 9 years unless they have been vaccinated previously. Children 3–8 years of age should receive one or two 0.5-mL doses of split-virus vaccine intramuscularly.
500
A 12-year-old white male is brought to your office after accidentally cutting his left hand with a pocketknife. On examination you find a deep 2-cm laceration at the base of the thenar eminence. To test for motor injury to the median nerve you would have the patient: A. Extend the thumb and fingers B. Oppose the thumb and little finger C. Flex the wrist D. Abduct the thumb and index finger
What is B. The ability to touch the tip of the thumb to the tip of the little finger indicates normal motor function of the median nerve.
500
Science magazine named it the "Breakthrough of the Year" in medicine for 2014.
What is cancer immunotherapy? Put simply, it is using drugs that spur the body's immune system to battle tumor cells directly. This usually does not happen naturally because tumor cells are able to wrap themselves in a protective shield. But new drugs are being tested that have been able to empower the immune system to break through that protection and allow the body to do its job in fighting cancer cells on its own.
500
The initial preferred imaging modality for a women, age less than 30, with a palpable breast mass is
What is ultrasound?