APEA Predictor Exam Missed Questions 2022/2023 with complete solutions

What is the biggest side effect of colchicine? - ANSWER diarrhea How would you describe the appearance of molluscum contagiosum? - ANSWER papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? - ANSWER no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSWER week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSWER week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSWER week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSWER week 28 At what week of pregnancy is the fundus just below the xiphoid process? - ANSWER week 34 Increased sweat production is a sign of what endocrine disorder? - ANSWER hyperthyroidism What is Paget's disease? - ANSWER there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures How do we treat Paget's diseease? - ANSWER bisphosphonates How should pregnant women wear their seatbelt? - ANSWER with the shoulder strap like a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? - ANSWER parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations? - ANSWER primary When should patients begin antiretroviral therapy for HIV infection? - ANSWER as soon as it is detected, even if in the acute phase What are the first generation antihistamines? - ANSWER diphenhydramine (benadryl) and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis? - ANSWER rash on hands and feet, lymphadenopathy, fever What is the recommended treatment for chronic bacterial prostatitis? - ANSWER a fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis? - ANSWER cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? - ANSWER clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSWER first generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSWER in those who are on any type of nitrate or triptan because it could result in hypotension What class of drug is sildenafil (viagra)? - ANSWER a PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What are the symptoms of peripheral artery disease? - ANSWER think P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What is first line treatment for PAD? - ANSWER walking and physical activity to improve circulation. second line is an aspirin or anti-platelet What should we tell our patients with PAD NOT to do? - ANSWER do not elevate the feet; keep them down How do we diagnose PAD? - ANSWER an ABI 7; doppler can also be used to diagnose as well but is the second choice What are s/s of peripheral vascular disease? - ANSWER think V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSWER Bactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSWER Rifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSWER decrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANSWER hold one dose then decrease the weekly dose by 10% If a patient's INR is greater than 5, what should you do? - ANSWER consult cards, likely would hold two doses then decrease the weekly dose An anorexic patient will have a BMI of what? - ANSWER less than 18 What is primary amenorrhea? - ANSWER when the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANSWER 3 months What do we need to do first when a patient comes in with secondary amenorrhea? - ANSWER rule out pregnancy Anorexia can put you at risk for what? - ANSWER osteoporosis, amenorrhea, cardiac damage Amenorrhea is considered a risk factor for what? - ANSWER osteoporosis What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSWER they get their period back If a pregnant woman has syphilis, what should we do? - ANSWER treat it with penicillin while she is pregnant because there is risk for spontaneous abortion What is the causative organism of mastitis? - ANSWER staph What is the first line treatment for mastitis? - ANSWER keflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is one of the biggest risk factors for cervical cancer? - ANSWER numerous sexual partners Preeclampsia most commonly shows up at what time in pregnancy? - ANSWER around week 20 How do we treat UTIs in a pregnant woman? - ANSWER can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSWER about 10 days before menses What can be a sequelae of an ectopic pregnancy? - ANSWER pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? - ANSWER test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? - ANSWER nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? - ANSWER give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSWER IUD The vaginal ring for contraception must be taken out how often? - ANSWER every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSWER increase the progesterone How do we treat temporal arteritis? - ANSWER steroids If a patient is on birth control and they miss one pill, what should they do? - ANSWER double up If a patient is on birth control and they miss two pills, what should they do? - ANSWER double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSWER do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSWER mammogram; ultrasound When do we screen for group B strep in pregnancy? - ANSWER weeks 35-37 When do we perform alpha fetoprotein screening in pregnancy? - ANSWER 15-20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSWER spina bifida and anencephaly What is placenta previa? - ANSWER when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - ANSWER when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? - ANSWER in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSWER a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSWER placenta previa What is the recommended treatment for polymyalgia rheumatica? - ANSWER steroids Patients with SLE are going to have what abnormal labwork? - ANSWER elevated ESR and CRP How do we treat lupus flares? - ANSWER steroids What are common sequelae of fibromyalgia? - ANSWER insomnia and depression What is a great treatment option for fibromyalgia? - ANSWER amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression How is fibromyalgia diagnosed? - ANSWER when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? - ANSWER when the femoral head of the hip is out of place What is the trendelenburg sign and when is it positive? - ANSWER when the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What is the main characteristic of a slipped capital femoral epiphysis? - ANSWER walking with a limp SCFE is most common in which patient population? - ANSWER adolescents What is legg-calve-perthe disease? - ANSWER avascular necrosis of the femoral head due to a lack of blood supply Legg-calve-perthes disease is most common in which patient population? - ANSWER young children What is the radiographic study of choice for the knee? - ANSWER MRI What is the radiographic study of choice for the back? - ANSWER x ray What is bursitis? - ANSWER a fluid collection in the bursa of a joint How is bursitis treated? - ANSWER a needle to instill intraarticular steroids and then pull off fluid Bursitis can be a __________ issue - ANSWER recurrent The medical term for knock knees - ANSWER genu valgum The medical term for bow legs - ANSWER genu varum What is myasthenia gravis? - ANSWER an autoimmune disorder that causes muscle weakness of the voluntary muscles Genu valgum is caused by a problem with what? - ANSWER the medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSWER the lateral collateral ligament What are shin splints? - ANSWER a medial tibial syndrome caused by overuse of the muscles How do we treat shin splints? - ANSWER rest and avoidance of exercise until the pain resolves What is the tell-tale difference between a herniated disc and sciatica? - ANSWER sciatica feels better when you stand, a herniated disc feels better when you sit down When will spinal or lumbar stenosis feel better? - ANSWER when the patient sits down What is Korsakoff syndrome? - ANSWER a deficiency in thiamine and folate caused by alcoholism What changes to the vagina occur with aging? - ANSWER dryness, loss of rugae, less pubic hair What is a navicular fracture? - ANSWER also known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSWER osteoarthritis; rheumatoid arthritis What is Morton's neuroma? - ANSWER a mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes How is Morton's neuroma diagnosed? - ANSWER via a positive Muddler's or squeeze test causing pain What is the hook test? - ANSWER used to assess for a bicep tendon issue How do we treat any rotator cuff injuries? - ANSWER wear a sling to stabilize the arm and refer to ortho How long do migraine headaches last? - ANSWER 4-72 hours How can we abort cluster headaches? - ANSWER calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? - ANSWER cluster headaches What does the apprehension test assess for? - ANSWER used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? - ANSWER when parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine What is the first line treatment for trigeminal neuralgia? - ANSWER carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - ANSWER steroids and anti-virals How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSWER in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? - ANSWER beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? - ANSWER adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? - ANSWER bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSWER molar pregnancy What bacteria is the leading cause of urethritis? - ANSWER neisseria gonorrhea What is the most common cause of hypercortisolism? - ANSWER excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? - ANSWER Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANSWER 5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? - ANSWER age 65 When should breast cancer screening begin and end with a biannual mammogram? - ANSWER age 50-74 When should colorectal cancer screening stop? - ANSWER age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSWER age 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSWER Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? - ANSWER LSIL If a patient has LSIL with a negative HPV test, what would you do? - ANSWER repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSWER refer for colposcopy If a patient's pap results show NILM, what should you do? - ANSWER repeat in 3 years If a patient's pap results show ASC-H or HSIL what should you do? - ANSWER refer for colposcopy The valgus stress test assesses what? - ANSWER the medial collateral ligament The varus stress test assesses what? - ANSWER the lateral collateral ligament The Lachman's test assesses what? - ANSWER the ACL The McMurray's test assesses for what? - ANSWER a torn meniscus The anterior drawer test assesses what? - ANSWER the acl The posterior drawer test assesses what? - ANSWER the posterior cruciate ligament (pcl) a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSWER dawn phenomenon How can you tell between the dawn and somogyi effect? - ANSWER If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon.