Questions and Answers
What are absolute contraindications to electroconvulsive therapy (ECT)?
There are no absolute contraindications to ECT.
What is the most appropriate initial treatment for community-acquired pneumonia in infants and children?
High-dose amoxicillin.
At what age is it recommended to introduce solid foods into the diet for normal term infants?
4-6 months of age.
What is the recommended treatment for midshaft posteromedial tibial stress fractures?
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What is the most appropriate test to screen for late-onset male hypogonadism?
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What is the first-line treatment for pediatric HSV-1 infection?
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What is the most accurate maneuver for detecting an ACL tear?
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What is the diagnosis of multiple myeloma based on?
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What findings are typical of femoral neuropathy?
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What decreases the risk of cancer for women using low-dose estrogen oral contraceptives?
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What are the clinical hallmarks of polymyalgia rheumatica?
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What are the three subtypes of frontotemporal dementia?
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What is the hallmark biochemical feature of refeeding syndrome?
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What methods can reduce the risk of oral candidiasis with inhaled corticosteroids for asthma?
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When should laryngoscopy be recommended for hoarseness?
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What are some causes of right heart failure?
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What are the metabolites of codeine-containing medications and diazepam?
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What is the most appropriate initial management of hypercalcemia of malignancy?
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Why is myomectomy preferred over fibroid embolization in some patients?
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What are the hallmarks of melanosis coli?
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What happens to the murmur of mitral valve prolapse with the Valsalva maneuver?
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What is the most common hip disorder in 8-15 year-old males and overweight/obese children?
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PEG tubes are associated w/ an increase in what?
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What is the highest risk group for colorectal cancer?
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What drugs are associated with drug-induced pleural disease/lupus pleuritis?
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What is the treatment for tachycardia in a patient with a history of Wolff-Parkinson-White syndrome?
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Is doxycycline contraindicated in pregnancy?
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Will steady extra caloric intake result in weight gain indefinitely?
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What is the initial medical management of asthma?
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Name some tumor necrosis factor inhibitors and the testing required prior to initiation.
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What tests are used to detect HCV antibody and determine active from past infection?
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What precautions should be initiated for a patient with an MRSA infection?
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What procedures should metformin be withheld for and what are the consequences of not doing so?
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What are the guidelines on combination therapy for nursing-home acquired pneumonia?
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Is there significant risk of congenital anomalies from SSRI use in pregnancy?
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Match the following classic presentations with their condition:
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What are the indications for teriparatide?
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What is the most likely infectious agent for acute dysuria, frequency, pyuria with no associated hematuria?
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What do you interpret if a patient takes 14 seconds on the 'Timed Get Up and Go' test?
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Match the following gait/balance disorders with their characteristics:
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What are the CDC recommendations on initiating treatment in a patient with suspected influenza?
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What are the recommendations for aspirin use in primary prevention of cardiovascular disease?
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Is there sufficient evidence to support the benefit/harm of aspirin use for cardiovascular disease prevention in individuals over 80?
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What populations are recommendations against the use of aspirin?
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What is known as 'nursemaid's elbow'?
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What is the appropriate management for fever in children under 29 days?
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What elements are part of the initial emergency department treatment for acute asthma exacerbations in children?
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What is the most common cause of death during the first 6 months of life?
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What documentation should lead to considering deliberate suffocation?
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What measures can help reduce calcium oxalate stone formation?
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What is the initial imaging modality for suspected stress fractures?
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What should you suspect in a patient presenting with metabolic acidosis of unknown cause?
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Study Notes
Electroconvulsive Therapy
- No absolute contraindications to electroconvulsive therapy (ECT).
Community-Acquired Pneumonia in Children
- Diagnosis primarily based on history and physical examination.
- Symptoms include fever, cyanosis, and abnormal respiratory findings.
- Outpatient antibiotics appropriate if the child is not toxic, hypoxemic, or distressed.
- High-dose amoxicillin is the preferred treatment.
Introduction of Solid Foods
- Recommended age to introduce solid foods to normal term infants is 4-6 months as the extrusion reflex disappears by 4 months.
Midshaft Posteromedial Tibial Stress Fractures
- Treated using an air stirrup leg brace (Aircast).
Male Hypogonadism Screening
- Total testosterone is the most appropriate initial test for screening late-onset male hypogonadism.
Pediatric HSV-1 Infection
- Acyclovir suspension is the standard treatment.
ACL Tear Detection
- Lachman test is the most accurate for detecting an ACL tear with a sensitivity range of 60%-100%.
- Anterior drawer test shows a sensitivity of 9%-93%.
- Pivot shift test shows sensitivity between 27%-95%.
Diagnosis of Multiple Myeloma
- Diagnosis requires evidence of end-organ impairment like hypercalcemia or renal failure, along with the presence of M protein or monoclonal plasma cells.
Femoral Neuropathy Symptoms
- Weakness in the lower left leg, knee giving way, and discomfort in the anterior thigh are typical symptoms.
- Commonly associated with diabetes mellitus.
Low-Dose Estrogen Oral Contraceptives
- Users have a 50% lower risk of ovarian cancer.
Polymyalgia Rheumatica
- Characterized by pain and stiffness in the shoulder and pelvic girdle with a dramatic corticosteroid response.
Frontotemporal Dementia Subtypes
- Includes behavioral variant, semantic dementia, and progressive nonfluent aphasia.
Refeeding Syndrome Biochemical Feature
- Hypophosphatemia is the hallmark biochemical feature.
Risk Reduction for Oral Candidiasis with Inhaled Corticosteroids
- Rinse mouth after each use of inhaled corticosteroids and use a valved holding chamber.
Laryngoscopy Recommendation for Hoarseness
- Recommended if hoarseness persists beyond 3 months or if a serious cause is suspected.
Causes of Right Heart Failure
- Left heart failure is the most common cause, followed by myocarditis, pulmonic stenosis, and ventricular septal defects.
Metabolites of Medications
- Codeine metabolism results in morphine, while diazepam metabolizes to oxazepam.
Management of Hypercalcemia of Malignancy
- Initial management involves intravenous normal saline.
Myomectomy vs. Fibroid Embolization
- Preference for myomectomy is indicated by the desire for future pregnancy.
Melanosis Coli Characteristics
- Notable by brown to black leopard spotting of the colonic mucosa due to anthraquinone laxative abuse.
Mitral Valve Prolapse and Valsalva Maneuver
- The murmur becomes longer and louder with the Valsalva maneuver.
Common Hip Disorder in Youth
- Slipped capital femoral epiphysis is the most common in males aged 8-15 years and in overweight/obese children.
PEG Tubes and Restraints
- PEG tubes are associated with an increased use of restraints.
Colorectal Cancer Screening Recommendations
- Highest risk group includes those with a first-degree relative diagnosed before age 60 or two second-degree relatives.
- Screening should start at age 40 or 10 years before the earliest diagnosis in the family, with rescreening every 5 years.
Drugs Inducing Pleural Disease
- Medications include hydralazine, procainamide, quinidine, amiodarone, bleomycin, cyclophosphamide, mitomycin, bromocriptine, methotrexate, and minoxidil.
Tachycardia Management in Wolff-Parkinson-White Syndrome
- Procainamide is the treatment of choice.
Doxycycline in Pregnancy
- Contraindicated during the second and third trimesters due to risk of permanent tooth discolouration.
Steady Extra Caloric Intake
- Weight gain will plateau rather than continue indefinitely.
Initial Asthma Management
- Low-dose inhaled corticosteroid daily with short-acting beta agonist (SABA) as needed.
Tumor Necrosis Factor Inhibitors
- Include infliximab, adalimumab, certolizumab pegol, and golimumab, requiring screening for TB, HBV, and HCV before initiation.
HCV Testing Protocol
- Detection through enzyme immunoassay, confirmation with recombinant immunoblot assay, and differentiation of active from past infection via RNA polymerase chain reaction.
MRSA Infection Precautions
- Strict handwashing by staff, visitors, and residents; implement barrier precautions for wounds and medical devices.
Metformin Use and Procedures
- Withhold metformin during procedures that reduce kidney function to prevent lactic acidosis.
Nursing-Home Acquired Pneumonia Treatment
- Recommended combination therapy includes antipseudomonal cephalosporins or carbapenems, antipseudomonal fluoroquinolones or aminoglycosides, and anti-MRSA agents.
SSRIs in Pregnancy
- Generally no significant risk for congenital anomalies except for paroxetine, which increases the risk of cardiac malformations in the first trimester.
Classic Pediatric Presentations
- Pyloric stenosis: palpable mass at 4-6 weeks.
- Choledochal cyst: triad of RUQ pain, jaundice, palpable mass.
- Meckel's diverticulum: painless GI bleeding in infants.
- Intussusception: colicky abdominal pain with palpable mass.
- Intestinal malrotation: bilious vomiting in the first 4 weeks.
Teriparatide Indications
- Used for severe osteoporosis, multiple risk factors, or failed bisphosphonate therapy.
Common Infectious Agents in Urethritis
- Urethritis likely caused by C. trachomatis, N. gonorrhoeae, or HSV if symptoms include dysuria and pyuria but no hematuria.
"Timed Get Up and Go" Test Interpretation
- 14 seconds indicates increased fall risk, while >20 seconds indicates severe gait impairment.
Gait and Balance Disorders Characteristics
- Cautious gait: wide stance and careful movements.
- Cerebellar degeneration: ataxic, wide-based gait.
- Frontal lobe degeneration: "magnetic" gait with hesitation.
- Parkinson's disease: shuffling gait with decreased step length.
- Motor neuropathy: steppage gait, excessive hip and knee flexion.
CDC Influenza Treatment Recommendations
- Initiate antiviral treatment based solely on clinical symptoms.
Aspirin Use for Cardiovascular Disease Prevention
- Recommended for men aged 45-79 for myocardial infarction prevention and women aged 55-79 for ischemic stroke prevention.
Insufficient Evidence for Aspirin Use
- Not enough evidence to recommend aspirin for cardiovascular disease prevention in those older than 80 years.
Aspirin Recommendations AGAINST Use
- Avoid in patients with fever >38.0°C, chest pain, orthopnea, wheezes, or rhonchi.
Nursemaid's Elbow
- Common injury in children under 5, occurring from a sudden upward pull, resulting in subluxation of the radial head.
Fever in Infants Under 29 Days
- Complete sepsis workup and admission required; common pathogens include group B Streptococcus and E. coli, treated with ampicillin and cefotaxime.
Acute Asthma Exacerbation Treatment in Children
- Involves repeated doses of a short-acting β2-agonist, correcting hypoxia, and possibly using IV magnesium sulfate.
Sudden Infant Death Syndrome (SIDS)
- Leading cause of death in infants aged 2-4 months, characterized by specific terminal activities and lividity.
Deliberate Suffocation Risk Indicators
- Consider if documentation includes infants over 6 months, prior sibling deaths, or specific pulmonary evidence.
Calcium Oxalate Stone Formation Prevention
- Low-sodium, restricted-protein diet, increased fluid intake, oxalate restriction, and potassium citrate to raise urinary pH.
Initial Imaging for Stress Fractures
- First-line imaging is plain radiographs; MRI serves as second-line if needed.
Suspecting Ethylene Glycol Poisoning
- Indicators include metabolic acidosis, renal failure, intoxicated appearance without alcohol odor, urinary crystals; treat with fomepizole. Ethylene glycol is found in engine coolant and cleaners.
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Description
Test your knowledge with this quiz on critical topics from the AAFP board review. Focus areas include absolute contraindications for electroconvulsive therapy and treatment protocols for community-acquired pneumonia in infants and children. Perfect for medical students and professionals preparing for board exams.