American Board of Family Medicine Notes

2010
 FACT: Female has slower gastrointestinal transient time (narrow therapeutic index meds)
 Dual antiplatelet should be stared after drug eluting coronary artery stent for  1 year
 Treatment of intrahepatic cholestasis of pregnancy  Ursodiol
 Rationale for treating Pertussis  reduce the risk of transmission to others
 FACT: Tarsal coalition  fusion of ≥ 2 tarsal bones, 50% bilateral, more with inversion
 FACT: Sever’s apophysitis  inflammation of calcaneal apophysitis, pain at heal
 Least likely antidepressants to cause weight gain  Bupropion (Wellbutrin)
 Lumbar spine stenosis pain increases with  lumbar spine extension
 FACT: NSAID should be avoided in cirrhotic liver disease patients (risk of bleeding)
 If delayed bone age + normal bone growth velocity  Constitutional delay
 If delayed bone age + Delayed/reduced bone growth velocity  GH deficiency and other DDX
 Best to diagnose psychogenic nonepileptic seizure  video EEG monitoring
 Pediatrics, low grade fever, decrease oral intake, shallow ulcer on posterior pharynx  Herpangina
 Same as above but shallow ulcer on anterior pharynx  Gingival-stomatitis (Herpes)
 Rosacea treatment  Metronidazole Gel
 Confirm the diagnosis of sexual abuse in pediatrics  Gonorrhea
 Cause of infected toe in DM patients  Streptococcus + Staphylococcus
 The lowest likelihood of neurological recovery after CPR  Myoclonic status epileptics 24hours
 Hypercalcemia, normal/high PTH, high urine calcium level  Primary hyperparathyroidism
 Hypercalcemia, low PTH  malignancy
 Hypercalcemia, low urine calcium excretion  Familial Hypocalciuric hypercalcemia
 FACT: when testing for Tb  IGRA differentiates mycoplasma tuberculosis from other types of Tb
 Amiodarone can be used for the treatment  sustained ventricular tachyarrhythmia in patients
with poor hemodynamically stability (last option)
 RX of thoracic vertebral compression fracture  decrease activity until pain lessens then follow up
in 1 week (management is conservative for 2 weeks if no improvement then surgery)
 Patients with 1 or 2 < 1 cm tubular adenoma + low grade dysplasia  re-examine in 5 – 10 years
 Vocal cord dysfunction  flattened inspiration, normal expiration
 RX of OA  start with acetaminophen
 Pain, swelling posterior to the medial malleolus, no injury, pain worse with inversion and weight
bearing, unable to preform single leg heel raise  DX (Tendinopathy of posterior tibial tendon) 
immobilization with cast for 3 weeks ( can lead to rupture if no RX)
 Sudden rise of creatinine in HTN patients  bilateral renal artery stenosis
 Pain between contraction, uterine tenderness, PV bleeding, fetal distress  placenta abruption
 RLS associated with  IDA, caffeine, SSRI or TCA, start RX if ferritin less than 50
 FACT: Norwalk virus can continue shedding long after acute illness
 To consider a positive TST test:
o ≥ 5 mm  immunocompromised
o ≥ 10 mm High risk group: nursing home, health care worker, homeless
o ≥ 15 mm  others
 One of the treatment for hiccups  chlorpromazine
 Elderly with h/o lower abdominal pain and pr bleeding  ischemic colitis
 Diverticulitis and angiodysplasia will be painless PR bleeding

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Done by: Dr. Noor Al Jasim
 Post op on heparin with thrombocytopenia  Heparin induced thrombocytopenia (occur 1 – 2
weeks after starting heparin) RX is stop heparin and start non heparin anticoagulation
 RX of chronic primary insomnia  CBT
 Elevated methylmalonic acid associated with deficiency of  vitamin B12
 Goal of BP in DM patient  130/80
 RX of MRSA with vancomycin should be monitored with  trough serum levels
 Femoracetabular impegment  most sensitive FADIR test (flexion, adduction, internal rotation)
 Can contribute to serotonin syndrome  Dextromethorphan
 The initial test to rule out adrenal insufficiency  morning serum cortisol
 Necessary to make diagnosis of polymyalgia rheumatic  bilateral shoulder or hip stiffness and
aching, it doesn’t respond to NSAIDS (only steroids), ESR more than 40
 The drug of choice to decrease respiratory secretion and is the least likely drug to cause CNS effect
like sedation  Glycopyrrolate
 Multiple PVC in ECG with no abnormalities next step  evaluate for coronary artery disease
 Non displaced radial head fracture RX  posterior splint and repeat xray in 1-2 weeks
 Testing for hyperaldosterinosim  serum aldosterone: renin ratio (+ if > 20:1 or aldosterone > 15)
 Another RX of lower back pain after NSAIDs and acetaminophen  Acupuncture
 Indication that the Hep B is in active phase  elevated ALT
 RX of subacute thyroiditis  steroids + NSAIDs
 Preop cataract surgery  no investigation needed
 Must be present in patients with IBS  abdominal pain
 One of the finding of early sepsis  Euothyroid sick syndrome ( low TSH and low T4)
 Sign of osteoporosis in adolescent  h/o stress fracture resulting from a minor trauma
 The most common cause of recurrent & persistent acute OM  penicillin resistant strep pneumonia
 RX of vib after failed defibrillation  vasopressin or epinephrine (amiodarone last option)
 Signs of malignancy in CXR  size > 10 mm, irregular border, ground glass appearance, doubling
time, no calcification.
 Rotator cuff tear RX  surgery
 To evaluate the usefulness of a test to either support or exclude DX  likelihood ratio
 The best RX (reduce mortality and morbidity) of MI and HTN  ACEI
 Metformin is CI if serum creatinine level is
o > 1.4mg/dl in female
o > 1.5mg/dl in male
 Exentide is contraindicated if eGFR is less than 30
 RX of lichen sclerosis  high potency steroids
 The child should face reward in car until he is  10 kg and 1 year old
 RX of fibromyalgia  TCA (Amitriptyline)
 MVA with wide mediastinum  partial rupture of thoracic vertebrae
 The initial SX of Hodgkin’s lymphoma  painless lymphadenopathy
 Hanta virus pulmonary syndrome caused via  mice
 Least likely to be associated with pseudo-addiction than true addiction  concurrent use of alcohol
or illicit drug
 RX of bronchiolitis  trial of nebulized albuterol
 Cough syrup should not be given for less than  2 years old (a9lan should not be given at all)
 Suspected melanoma  excision with 1 mm margin
 Treating sexual partner should be initiated in  PID

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Done by: Dr. Noor Al Jasim
 HhA1c% of 7 corresponds with RBS of  8.5
 Anxiety disorder ABG: respiratory alkalosis  high pH, normal O2 and low PCO2
 Elderly with personality and behavior changes  frontotemporal dementia
 FACT: CT scan chest is more hazardous than abdominal CT
 Test of vitamin D deficiency  25, hydroxyvitamin D
 Not required for patient to be legally decision making capacity  absence of mental illness
 The commonest cause of incontinence in elderly  detrusor instability (become worse after TURP)
 Prophylaxis before going to Mexico  Rifaximin
 To decrease hirsutism with abnormal menstruation  spironolactone (antiandrogenic)
 Osteoporosis with a family history of breast cancer  Raloxifine
 Chlamydia treatment  azithromycin 1 gram
 Slowly progressive memory loss with dementia and urinary incontinence  normal pressure
hydrocephalus
 In treating HTN if the patient is asthmatic or have heart block  no BB
 In treating HTN if the patient has heart block  no CCB
 In treating HTN if the patient is DM then give  ACEI
 Rash after gadolinium CT and patient on hemodialysis  biopsy is indicated (gadolinium associated
nephrogenic systemic fibrosis)
 Decontamination in the 1st hour is done by  oral activated charcoal
 DM pregnant then use combination of  intermediate insulin (NPH) + short acting (Lispro) BD
 Azithromycin associated with  long QT syndrome
 Sogren’s associated with  AntiSSA and andtiSS B
 Suspected infective endocarditis  RX with vancomycin and gentamycin
 Polycythemia vera DX  high hematocrit, high Hb, high platelet, low EPO
 Neck LN than is non tender and less than 3 cm  monitor clinically for 4-6 weeks then BX if enlarge
 Acintic keratoisis progress to  squamous cell carcinoma
 Cross reactive food allergy for latex  avocadoes
 Thyroid nodule more than 1 cm  FNAC
 Donepezil associated with  bradycardia needing pacemaker (cholinesterase inhibitor for AD)
 Regimen mimic normal insulin  detemir (Levemir) + rapid acting insulin with meals
 High FSH high LH  ovarian failure
 When assessing dehydration in children, what is NOT useful  BUN creatinine ratio
 Herbal medication that can lower lipid profile  red yeast rice (need monitoring with LFTs)
 Inhaled corticosteroid in COPD can lead to  increase risk of pneumonia
 Healthy 1 month old infant should take vitamin D with dose of  400 IU
 Dilated cardiomyopathy  low EF, thin wall, diffusely enlarged ventricle
 Restrictive cardiomyopathy  ↓ ventricular volume, normal LV wall thickness & systolic function
 Elevation of ALP + 5’-nucleotidase indicated involvement of  liver
 The most common cause of secondary nephrotic syndrome in adults  DM
 Electrolyte abnormality associated with bulimia  Hypokalemia (vomiting and laxative use)
 Peritonsillar abscess  difficulty opening his mouth (trismus)
 Varenicline for smoking cessation SE  nausea
 Circumflex artery occlusion in ECG  I, avL, +/- V5, V6
 LAD artery occlusion in ECG  V1 – V6
 RCA artery occlusion in ECG  II, III, avF (inferior wall MI)

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Done by: Dr. Noor Al Jasim
2011
 RX of mid shaft posteromedial tibial stress fracture  air stirrup leg brace (Aircast)
 Screening for late onset male hypogonadism should be done with  total testosterone (if low then
do free testosterone level) then FSH, LH  if both high with low testosterone then primary
hypogonadism (testicle) if both are low with low testosterone then secondary hypogonadism
(problem is in hypothalamus)
 HSV1 infection in kids  multiple ulcers, RX  Acyclovir
 ACL most sensitive test  Lachman test
 COCP decrease risk of cancer of  Ovaries
 Refeeding syndrome associated with  hypophosphatemia
 Sigmoidoscopy showing black leopard spotting of colonic mucosa  associated with laxatives use
 Valsalva maneuver intensify systolic murmur in  HOCM
 PEG tubes are associated with  increase use of restrains
 Pain with eye movement is associated with  orbital problem
 Screening if + FH of colon cancer 50 or 10 years younger than FH and every 5years if normal
 Associated with dry induced pleurisy  hydralazine
 Drug to use in WPW  procainamide
 CI in 2nd and 3rd trimester  Doxycycline (permanent discoloration of teeth)
 Safe antidepressant during pregnancy  Fluoxetine (Prozac) is okay with Fetus
 Osteoporosis treatment that is use for severe osteoporosis with failed RX  Teriparatide
 Sterile pyuria  chlamydia trachomatis
 Anorexia nervosa RX  family based treatment
 IDA with RBC poikilocytosis  start prescribing oral iron (no need investigation)
 Preliminary screen for Crohn’s disease  CBC, biochemistry and ESR
 Medication that should be avoid to prevent deterioration in kidney function  ibuprofen
 RX of symptomatic MVP  propranolol
 To prevent motion sickness  Acetazolamide if allergic (sulfa) then Dexamethasone
 Causing most cases of interstitial nephritis  antibiotics
 Seafood poisoning that need more than supportive RX  scomborid fish
 POTS (postural orthostatic tachycardia syndrome) ↑HR by 30bpm or HR120 within 10min standing
 The greatest risk for AAA  smoking
 Omeprazole SE  osteoporosis and vitamin B12 deficiency
 Activation of the sympathetic nervous system will lead to decrease in  PR interval
 The most effective topical therapy for psoriasis  high potency steroid
 Intertrigo RX  Erythromycin
 Chronic paronychia RX  1- topical steroid 2- Oral antifungal
 Presbycusis hearing loss is  high frequency
 Patellofemoral pain characteristic  inadequate hip abductor strength
 Drug that reduces insulin resistance  Pioglitazone (actos) it is thiazolidinedione
 The most effective method for smoking cessation  behavioral intervention
 Vacuum delivery is more associated with  increase incidence of shoulder dystocia
 GE due to Ecoli need to monitor  renal function test (HUS)
 Depressed with low eight and insomnia give  Remeron mirtazapine (SNRI) increase appetite
 Flattened inspiratory lobe  vocal cord dysfunction
 Nurse maid elbow  subluxation of head of radius
 SIDS occur from ages  2 – 4 months old

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Done by: Dr. Noor Al Jasim
 Suspected ethyl glycol poisoning antidote  Fomepizole
 RX of essential tremor  BB then primidone
 Urge incontinence RX  behavioral therapy then oral anticholinergics
 RX of MRSA  vancomycin OR doxycycline
 Vitamin D supplement should be started at the age of  2 months
 Alcohol with drawl drug  BZD
 Beefy red pruritic rash around anus caused by  group A streptococcal pyogens
 Associated with high dose methadone  prolonged QT and torsade de pointes
 HSV genitalia is best tested with  PCR (95% sensitive)
 Opioid SE that does not diminish over time  constipation
 Suspected RA treatment  methotrexate (DMARDS)
 Persistent urethral discharge after RX of gonorrhea + chlamydia  give metronidazole
 2 doses of varicella vaccination are recommended for  all children with normal immune status
 The most appropriate RX for Batonella henseale (cat bite)  Azithromycin
 The threshold for prophylactic platelet transfusion  10,000
 Best drug to prevent hip fracture  alendronate
 Adjuvant treatment of venous ulcer besides compression  pentoxifylline (Trental)
 Prophylactic against Lyme disease  doxycycline
 5mm pulmonary nodule found on CXR, next step  CT scan
 Palliative care has been shown to  decrease depressive symptoms
 VSD  4/6 pansystolic murmur + combined ventricular hypertrophy
 67 years old with community acquired pneumonia should be covered for  Legionella
 The most specific sign for autism  delayed attainment of social skill milestone
 Reduce the incidence of atopic dermatitis in children  exclusive breast feeding in 1st 4month
 Decreases with age  cardiac output
 Children with migraine in need prophylaxis  BB as (amitriptyline will worsen constipation)
 In HSP the organ that will lead to assessing the prognosis  kidney
 Drug that should be avoided in elderly due to CNS SE  indomethacin
 Pes anserine bursitis the tenderness is mainly in  medial proximal tibia
 Found helpful in IBS via RCT  peppermint oil
 To evaluate for renovascular HTN  duplex Doppler US
 To prevent social phobia  beta blockers
 To r/o DMD  serum creatinine kinase
 Initial dose of warfarin should not exceed  5mg
 Intermittent claudication RX  Cilostazol
 RX of clostridium difficile  PO metronidazole twice (if mild symptoms) then vancomycin
 Osteoporosis should be screened in all female above 65 years old and all males above 70 years old
 Ascites RX  spironolactone (aldactone)
 NOT killed by alcohol based hand disinfection  clostridium difficile
 Cutaneous lava migrans is a  hook worm
 Sudden painless unilateral loss of sight  cherry red spot
 Boxer # (5th metacarpal head) RX  ulnar gutter splint, surgery if angulation more than 30-40

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Done by: Dr. Noor Al Jasim
2012
 Suspected bronchiectasis in 70 years old already made CXR, next step  CT scan
 Suspected sinusitis for > 10 days with no improvement  start oral antibiotics
 Suspect lichen plannus RX  high dose topical steroid (Clobetasol 0.05%) ointment
 Should be referred immediately due to speech delay:
o No babbling at 12 months
o No mama, dada at 18 months
o 2 years with vocabulary < 25 words
o 3 years with vocabulary < 200 words
o No 2 step command at 2 years old
 Hereditary hemorrhagic telangiectasia (Osler weber Rendu syndrome associated with  pulmonary
arteriovenous malformation
 Change in olfactory can be associated with deficiencies of  vitamin B6, B12 and A (not D)
 Dysthymic  depressed mood for 2 years, no mania or hypomania
 Immigrant, 1 week low grade fever, non-productive cough, urticaria, hepatosplenomegaly, crackles
but no consolidation, CXR  several oval infiltrate 1-2 cm in size  Ascaris Lumbricoides
 Nurse with arthralgia, malaise and nonpruratic rash  Parovavirus B19 (5th disease)
 Confirm spontaneous bacterial peritonitis  Neutrophils more than 250/ml
 Can prevent both vertebral and hip fracture  Zoledronic acid (Reclast)
 SIADH  ↑ ADH  ↓ serum Na  hypertonic urine  urine Na > 20mEq/L
 Dress syndrome  ↑ LFT, eosinophils, LN, erythroderma and fever, RX  corticosteroid
 Redman syndrome associated with  vancomycin
 ENT examination associated with DM  parotid enlargement
 Most likely drug to cause symptomatic hypoglycemia  Glyburide (DiaBeta)
 BNP < 100  think other DDX than HF
 ACEI MOA  impair autoregulation of glomerular blood flow
 Diagnosis of Osgood schaltter disease is made by  history and physical examination
 5 days before given birth or 2 days after  given varicella Ig, the vaccine is CI in pregnancy
 The most common cause of traveler’s diarrhea  E coli
 Heart disease murmur  increase intensity with standing, ≥3/6, holosystolic, diastolic, abnormal S2
 Pleural effusion  decrease fremitus, pleural consolidation  increase fremitus
 Pertussis treatment  Azithromycin or Erythromycin
 Smoker with hoarseness > 2 weeks then do  laryngoscopy
 Patient on statin should avoid herbal  St. John’s wort
 Causes of hypercalcemia  primary hyperparathyroidism, hydrochlorothiazide, lithium
 Physicians are more likely to suffer from  prescription drug abuse
 Campylobacter enterocolitis RX  Erythromycin or Azithromycin
 Neonatal CPR should be started in HR is  < 60 bpm
 Infants double their weight at 4-6 months and triple it at 12 months
 Effective therapy for myocarditis induced dilated cardiomyopathy  Lisnopril (ACEI)
 Surgical management of congenital pectus excavatum should be done at  adolescent age
 Refractory anaphylaxis not responding to epinephrine  give glucagon (antidote BB)
 Onychomycosis RX  oral Terbinafine (Lamisil)
 Suspected septic arthritis must do  arthrocentesis
 Management of hypotension in patient with sepsis  NS + norepinephrine
 Most likely to cause hypoglycemia if used as monotherapy  Repaglindine (Prandin)

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Done by: Dr. Noor Al Jasim
 Should be referred in scoliosis if angle is  20
 Folate deficiency associated with  high Homocysteine
 Leading cause of death in RA  cardiovascular diseases
 Associated with testosterone replacement in men with hypogonadism  infertility
 The most likely anti smoking drug that causes weight gain  Varenicline
 Polymyalgia rheumatic RX  prednisolone 15mg daily with slow taper
 Can treat hot flushes as well as depression  Escitalopram
 Severe vertigo for 1 day, normal neurological testing, no tinnitus or hearing  vestibular neuritis
 Amiodarone causes hyper or hypothyroidism
 Lithium causes only hypothyroidism
 Approved for RX of lice for < 1 year old  benzyl alcohol lotion (Ulesfia)
 Can help in PMS  vitamin B6 (pyridoxine)
 Gastroenteritis
o Less than 6 hours  staph aureus
o More than 6 hours  campylobacter jejuni
o Blood  shigella
 Arrhythmias associated with antipsychotics use  ventricular fibrillation (torsades de pointes)
 Consistent with infantile seborrheic dermatitis  resolution from weeks to months
 Croup RX  single dose po steroid, it is caused by parainfluenza virus, if severe inhaled epinephrine
 Asthma be careful in Question  there is a step down approach as well
 The most effect COCP in obese women  Nuvaring
 To decrease stroke risk in CABG  post op aspirin
 ADHD in children
o < 7 years old  CBT
o ≥ 7 years old  medications (Ritalin) methylphenidate
 Interstitial cystitis RX  pentosane polysulfate sodium
 Poison ivy RX  high dose prednisolone taper in 14 – 21 days
 Screening for colorectal cancer should be done  yearly
 Wells criteria for DVT:
o High and intermediate risk  do compression ultrasound
o Low risk  do DD level
 Brain tumor in need for gadolinium contrast for MRI at risk of  nephrogenic systemic fibrosis
 Reduces calcium carbonate absorption  PPI
 Can be successfully treated with extracorporeal shock wave therapy  calcific tendinitis
 The commonest cause of infective endocarditis worldwide  staphylococcus aureus
 Middle age women, pruritus, high ALP, high GGT, high AMA  primary biliary cirrhosis
 Suspected scleritis associated with CTD  Oral NSAIDS
 Associated with inferior wall MI  RV infract
 Dermatological disease associated with DM  eczema craquele (xerotic eczema)

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Done by: Dr. Noor Al Jasim
2013
 HTN, hyperlipidemia sudden CKD with HB in urine, negative RBC  rhabdomyolysis
 Erythema marginatum  annular rash with bright red outer border and partial central clearing
 Squamous cell carcinoma associated with  high Ca, high PTH, high ADH
 The most common cause of GE on cruise oysters  Norovirus
 Obstructive lung disease asthma and COPD  ↓ FEV1 and ↓ FEV1/FVC ratio
 Restrictive lung disease  ↓ FVC and normal or ↑ FEV1/FVC ratio
 If suspected conjunctivitis n infant due to gonorrhea, RX  IM ceftriaxone
 Effective in treating common cold in adults  intranasal ipratropium (atrovent)
 The best time to vaccinate for rubella in pregnancy  immediately post partum
 Clue for HTN medications starting:
o Migraine / tachycardia  beta blockers
o Raynoud phenomenon  CCB
o BPH  alfa blocker
o Osteoporosis  thiazide diuretics
 CI to give Zoledronic acid  eGFR < 35 or evidence of acute renal failure
 Abnormality seen in stage 4 kidney disease  hyperparathyroidism
 Reservoir for hantavirus  Deer mice
 PCOS patients are at risk of carcinoma of  endometrium
 Anorexia nervosa vital signs  bradycardia and hypotension
 Vaccine that is CI in immunocompromised  herpes zoster (live attenuated)
 Use of analgesia during labor increase the risk of  instrument assisted vaginal delivery
 MOA of Sevelamer  block intestinal absorption of phosphate which lowers PTH secretion
 OSA in peads RX adenotonsillectomy
 Renal stone that needs acidification of urine  calcium phosphate
 Calcaneal apophysitis or server disease  common in children associated with heel pain with
activity that increase with passive dorsiflexion of ankle, RX  decrease activity + anti-inflammatory
 RX of SCFE  surgery
 Any patient with ALTE need  admission
 RX of pregnant with positive Group B streptococcus  penicillin, if allergic  Cefazolin
 AAA screen via US should be done for  men aged 65 – 75 who ever smoked (once)
 Pneumonia with GI and neuro SX the cause is  legionella pneumophila
 1st line RX of CAD with HTN  beta blockers (reduce death by 23% in 2 years)
 Antidote of mg (h/o treating severe eclampsia)  Calcium gluconate
 Mid systolic ejection murmur loudest on right USB  aortic stenosis
 CI in cirrhotic patients  naproxen (risk of heaptorenal syndrome)
 Tamiflu and pregnancy  safe
 Paget’s disease  pain is continuous unlike OA
 ABI > 1.4 indicates  non compressible arteries (calcified)
 Occur with age  decrease maximal heart rate with exercise
 CI in HF  Verapamil (CCB)
 Used to treat osteoporosis as well as pain from vertebral compression fracture  calcitonin
 RX of hypoactive sexual desire in female  topical testosterone
 More likely to occur with aromatase inhibitor than tamoxifen  myalgia
 Myelodysplastic syndrome  thrombocytopenia, leukopenia, macrocytic anemia
 Mallet fracture  splint it in full extension, surgery if > 30%

8
Done by: Dr. Noor Al Jasim
 The best to treat depression in patient with life expectancy less than 1 month  Ritalin (others take
1 month to work)
 Legally responsible for the patient to be notified of mammogram results  the facility
 Heat stroke is different than heat exhaustion by  change in mental status
 CI to bupropion  seizure disorder
 Can be used in the RX of constipation related to opioid  polyethylene glycol
 Refeeding syndrome  hypophosphatemia
 To be impaired in early dementia  cooking
 In toeing can be normal up to the age of  8 years old
 Noise induced hearing loss  drop notch at 3000 – 4000 Hz
 Combination of ACEI + ARB can lead to  increase in creatinine level
 Is NOT detected in urine drug screen  fentanyl
 Psychiatric drug that can lead to agranulocytosis  Carbamazepine (tegretol)
 1st line therapy for mild to moderate Alzheimer’s disease  Donepezil
 To indicate ACL tear  Lachman’s test
 To test for meniscal tear  Thessaly test
 Testosterone treatment can lead to  polycythemia
 Best contraception for seizure disorder  IUCD mirena
 Patient on aspirin and clopidogrel going to surgery, next step  stop only clopidogrel 5 days before
 Misleading hyponatremia can be result of  hyperglycemia, hypertriglyceridemia
 Incidental discovery of sarcoidosis  no treatment unless the patient become symptomatic
 The most likely therapeutic intervention for cor pulmonale  oxygen (long term)
 Timed up and go test to assess fall  rising from chair walking 3m or 10 feet walking back and
sitting in chair should be done in an average 60 years old man in 10 seconds
 Methanol antidote  ethanol
 The most effective method of natural family planning  cervical mucus monitoring
 Still birth (fetal death after 20/52)  1/3 chromosomal anomalies and rest is placenta
 Meniere’s disease  vertigo, hearing loss, tinnitus
 Bipolar II RX  Divalproex (Depakote)
 Suspected malrotation/volvulus  upper GI series
 Juice that can increase the blood level of statin  grapefruit
 Long term management of SVT/afib  radiofrequency ablation
 Improve outcome in ARDS  low tidal volume
 Fetal alcohol syndrome  thin upper lips, smooth philtrum, flat nasal bridge, small palpebral fissure,
curved 5th finger (clindodactyly) widened upper palm crease b/w 2nd and 3rd finger
 Pericarditis pain improve when  sitting up and leaning forward
 h/o of exposure to Hep A in non-vaccinated child:
o < 1 year old  give immunoglobulin only
o > 1 year  Hep A vaccination only
 Orthostatic hypotension the BP should be measured with interval of at least  3 minutes
 OCP that can lead to hyperkalemia  Yasmin PO drospirenone/ethinyl estradiol
 Erysipelas organism  Streptococcus pyogenes
 AST: ALT > 2 with high GGT  alcoholic liver disease
 Cause of intertrigo  candida albicans
 Anal fissure give topical  nitroglycerin
 Last option for resistant HTN  add spironolactone

9
Done by: Dr. Noor Al Jasim
 Occur with delirium rather than alcohol withdrawal  fever
 Heroin overdose can cause acute  pulmonary edema
 Hydralazine can treat both heart failure and hypertension
 Paradoxical chest movement in asthmatic patient life threatening
 Prophylaxis for pertussis  oral azithromycin for 5 days
 To diagnose primary biliary cirrhosis  AMA antibodies (anti-mitochondrial antibody)

2014
 Rosacea treatment  Topical metronidazole or Oral doxycycline
 To prevent damage from gout, uric acid level should be below  6 mg/dl
 Further evaluation of microcytic anemia is ferritn level, if low it indicates IDA if normal then check
serum iron, total IBC, transferritin saturation, peripheral blood smear and retics
 Drug that causes gynecomastia  spironolactone
 FACT: booster of Tdap should be given if the last dose was ≥ 5 years back
 Xray  quadriceps tendon rupture
 RX of group A streptococcal pharyngitis  penicillin
 Morphine should be avoided in  stage 4 kidney disease
 Cancer patient with mets coming with fatigue, hyponatremia, hypercalcemia, hyperkalemia,
hypoglycemia  give cortisone (adrenal insufficiency with mets)
 To assess early osteomyelitis  MRI
 Lichen simplex with DM, RX  topical steroids
 antiHTN medication that can be affected by Hpylori treatment (i.e. clarithromycin)  amlodipine
(CCB) as both metabolize by P4503A4 enzyme
 any lesion in face that is > 1 cm confirmed to be BCC need to  Mohs micrographic surgery
 the best long term pain relief in tennis elbow  expectant/conservative management
 hyperplastic polyp that is less than 1 cm need follow up every  10 years
 to diagnose pertussis  nasopharyngeal culture + PCR testing (the best)
 BP in children is based on  sex, height and age (70+ (age X2))
 35 years old female with chronic abdominal pain + tender red nodule on shin  Crohn’s disease
 Risk factor for long recovery from sport associated concussion  headache lasting > 60 hours
 SE of long term use of opioids  hypogonadism
 Elderly with soiling  overflow after constipation
 Syncope with activity  aortic stenosis
 Lyme disease RX  single dose of 200mg doxycycline
 Associated with subacute granulomatous thyroiditis  low radioactive iodine uptake < 5%
 Lichen plannus  associated with Hep C + involvement or oral mucosa (6Ps) RX topical steroids
 The best pain killers for end stage renal disease  fentanyl + methadone
 Neurological examination of power
o 0  no movement
o 1  contraction of muscles, no movement
o 2  movement with gravity
o 3  movement against gravity
o 4  movement against gravity with resistance
o 5  movement against gravity with substantial resistance

10
Done by: Dr. Noor Al Jasim
 Screening for lung cancer with low dose CT scan  age 55 – 80 with 30 pack year currently smoking
or quit smoking 15 years back
 Prophylaxis for cluster headache  verapamil 160 – 320 mg q6-8 hourly
 The best initial RX for Parkinson’s  carbidopa/levodopa
 A higher dose of warfarin will be needed if the patient is found to have  hypothyroidism, DM,
Cancer or hyperlipidemia
 To check for Tb in already vaccinated individual  IGRA
 Salter Harris  1 separated, 2 above, 3 lower, 4 through (meta,epi physis), 5 crush physis
 Supraclavicular LN (Virchow’s node)  associated with GI malignancy
 Palpable non tender GB  Courvoiser’s sign (tumor)
 Can treat depression and chronic pain and wont cause weight gain  Duloxetine
 Should be stopped during pregnancy  beta blockers (atenolol)
 Pitryasis rosea associated with syphilis  need to do RPR test
 The best to diagnose inflammatory bowel disease  colonoscopy with biopsies
 Best time to take Tdap vaccination in pregnancy  between 27 – 36 weeks of gestation
 Medications that can cause acute interstitial nephritis  PPI, NSAIDs, diuretics, penicillin
 Pressure ulcer prophylaxis is need for  until the patient is transferred from the ICU
 Uveitis RX  ocular steroid
 The first line RX for midsubstance achilles tendinopathy eccentric exercise
 RX of acute sinusitis in patient allergic to penicillin  Cefuroxime
 Suspecting necrotizing skin infection u must cover  group A streptococcus
 HIV patient with CD4 count less than 200 should be given prophylaxis against  pneumocystis
 Legg Calve Perthes disease  limited abduction, age 2-12, sclerosis of proximal femur, wide joint
space and short leg
 1st line RX of PCOS  hormonal contraception (I disagree)
 The use of atypical antipsychotics: olanzapine in  ICU related delirium
 CI in the management of post partum hemorrhage + HTN  methylergonovine
 CI in the management of post partum hemorrhage + asthma  Carboprost tromethamine
 FACT: colon Ca screening for ulcerative colitis 10 years after diagnosis then every 2 – 5 years
 Tramadol should be avoided in  seizures patient
 Depo provera SE  weight gain
 Peads with neck lump, ABX already give  wait 1 month and reassess
 The safest NSAIDs if H/o MI  Naproxen
 Pneumonia  60 days – 5 years  Amoxicillin, 5 – 16 years  azithromycin
 Keloid RX  intralesional steroids
 Can cause false opioids in urine drug screen 00> Dextromethorphan, ibuprofen, fluoroquinolone,
diphenhydramine
 Colle’s fracture RX  sugar tong splint or short arm cast
 ADHD treatment in adults can lead to  increase BP
 Lower BP in stroke only if it reaches  220/120
 Site of ER airway  cricothyroid membrane
 Initial approach for painful limp  CBC + ESR
 Calcium supplements should be taken in the form of  calcium citrate (@least 1200 daily)
 Suspected cauda equine syndrome  urgent MRI of spine
 Plaque psoriasis RX  topical steroid + Vitamin D (Clobetasol) 0.05% cream BD
 Dengue fever low WBC, high CPK, high LFT, spiking fever, thrombocytopenia RX NSAIDS +aspirin

11
Done by: Dr. Noor Al Jasim
 Stretching has no benefit for  joint contracture
 Empirical RX for fever in less than 3months old  ampicillin + cefotaxime (claforan)
 Frostbite RX  leave simple non tense area of clear blistering intact
 The most likely cause of Steven Johnson Syndrome  allopurinol
 Taking fish oil supplement decrease the level of  Triglyceride
 Crohn’s disease patient on infliximab should not get  zoster vaccination (live attenuated)
 A common cause of prerenal kidney injury  diuretics use
 Staccato cough  chlamydia infection
 Diastolic HF  LVH, normal EF (50-55%), systolic HTN
 The longest cause of relief in carpal tunnel syndrome  surgery then local steroid injection
 Odd behavior and belief, always anxious  Schizotypal personality disorder
 Not a risk factor for still birth  vigorous exercise
 The first line therapy for urge incontinence  bladder training
 Contraindicated antibiotics with statin  clarithromycin (metabolize by the same enzyme)
 Screening for primary hyperaldosteronism  morning serum renin aldosterone ratio
 If h/o mild egg allergy  give trivalent flu vaccine and wait for 30 minutes
 DM should be vaccinated against  Hep B (multiple blood sugar checking)
 Best diet for mild acute pancreatitis  low fat diet

2015
 1 month old with conjunctivitis, SOB, poor feeding, afebrile, CXR showing hyperinflation and diffuse
interstitial infiltrate, high WBC and eosinophilia  chlamydia trachomatis
 Not effective in the treatment of bipolar disorder  haloperidol
 Nurse maid elbow RX  attempt reduction of subluxed radial head
 Drug that should be started at low dose and titred to prevent Steven Johnson syndrome 
Lamotrigine (lamictal) antiepileptic used for bipolar disorder
 FACT: EBM  meta-analysis are better than guideline
 Definition of microscopic hematuria  urine showing ≥ 3 RBC on 2 separate occasions 6 weeks apart
 RX of SOB in hospice with cancer  opioids
 Prolonged QT syndrome patient should avoid antibiotics  clarithromycin
 The use of ICS in COPD lead to  increase risk of bruising + bone loss + pneumonia
 Polymyalgia rheumatic will show respond to treatment with  prednisolone
 Causes of SIADH  SSRI (centrally acting drug)
 Diabetic foot ulcer RX  Zosyn + vancomycin (must cover MRSA)
 Initial RX of pericarditis  NSAIDs + colchicine
 Suspected Turner’s syndrome in 13 years old do  karyotyping
 FACT about RSV virus  rarely associated with bacterial co-infection
 Non displaced mid shaft clavicle fracture with figure 8 is equal to = shoulder sling
 Vaccination that associated with increased risk of febrile seizure  MMR
 Valgus stress in 100% sensitive for  ulnar collateral ligament injury
 FACT: live attenuated intranasal influenza vaccine is more effective in 2-6 years old than inactivated
 In COPD with pneumonia you should cover for  pseudomonas
 Alcohol withdrawal OPD RX  chlodiazepoxide
 Cows milk is not recommended under the age of  1 year old
 RX of lateral dislocated patella  medially directed pressure on the patella with leg extension

12
Done by: Dr. Noor Al Jasim
 Must be done before starting OCP  BP check
 RX of multiple sclerosis flare up  PO steroid
 Serotonin syndrome treatment  benzodiazepine
 High unconjugated bilirubin DDX  gilbert syndrome
 To help reduce the pain of lidocaine  buffer the solution with sodium bicarbonate
 Best management for fever in asplenic patient  empirical antibiotics
 Should get 2nd dose of pneumococcal vaccine in child who has  SCD
 Infertility in 30 years old female with normal examination  do luteal phase progesterone at day 21
if it is less than 5 then do TSH, FSH, estradiol and prolactin
 Suspected SAH with negative non contrast CT then do  LP
 Best to treat fecal impaction in an 18 months old  oral osmotic agent (polyethylene glycol)
 The 1st step of evaluating hemoptysis (even for 3 days in 42 year old)  CXR
 The best RX for recurrent urticaria  H1 histamine blocker
 Cause a significant risk factor for esophageal adenocarcinoma  obesity
 Cause of acute pyelonephritis is E.coli, RX  fluoroquinolone
 Ana psoriasis pic  topical steroid
 BP goal:
o < 60 + no co-morbidities  140/90
o > 60 + no co-morbidities  150/90
o > 60 + co-morbidities  140/90
 Positive nissereria meningitis prophylaxis is given for  very close contact only
 Tamoxifen SE  increase risk of endometrial cancer
 Copper is preferred over Mirena if there is h/o  liver cirrhosis
 Umbilical cord has  2 arteries and 1 vein
 Trochanteric bursitis RX  corticosteroid injection (lateral hip pain), everything else normal
 Rhabdomyolysis RX  IV NS
 In animal bite you will need antibiotics if the bite involved  the hand
 1st line RX for polycystic kidney disease  ACEI
 Pseudoephedrine in elderly can cause  worsen urinary retention, ↑BP, ↑HR, ↑intraocular pressure
 Increase in geriatric population  the % of body fat
 Least likely NSAIDs to causes heart problems  Naproxen
 HSP you should avoid giving  Ibuprofen
 Detect Duchene muscular dystrophy via  creatinine kinase level
 Must be done for Kawasaki patients  echo
 Any suspected hyperthyroidism with High uptake on radioactive iodine scan is  Graves disease
 Before starting prophylactic HIV medications to any person with high risk you must  do antibody
testing for HIV (to document a negative HIV)
 Bioterrorism substance that need RX of 60 days antibiotics  anthrax
 Pet reptile is most likely to transmit  salmonella
 Testosterone replacement therapy should be monitored with  hematocrit level
 One of the causes of osteoporosis in men is  low testosterone level
 Associated with resistant HTN  OSA
 The anatomical location for steroid injection of shoulder  sub-acromion space
 FACT: posterior rib fracture is child abuse until proven otherwise  admit the child
 Pre-eclampsia after 37 weeks of gestation  admit for induction of labor

13
Done by: Dr. Noor Al Jasim
 Patient with day time drowsiness, falls asleep after reading or watching TV with episodes of sudden
loss of muscle tone lasting 1 min with laughing, DX  Narcolepsy, RX  Ritalin (methylphenidate)
 Medication that can cause interstitial lung disease  Nitrofurantoin
 1 of the sign of autism  becoming upset with normal noises
 Other RX of IBS  TCA (amitriptyline)
 If severe egg allergy then influenza vaccine can be given as  recombinant trivalent flu vaccine
 The best long term result for tear in medial meniscus  continued physical therapy
 To check hypogonadism, first  total testosterone level
 Can lower the risk of preeclampsia in pregnancy  aspirin 60-80 mg OD
 All DM patient should be on  moderate – high intensity statin
 Can be used in pain management in ESRD  fentanyl (99% hepatic elimination)
 Boggy non tender mass in elbow after bumping it  compression dressing
 Lyme disease prophylaxis after removing a tick  doxycycline
 One of complication of hypothyroidism  refractory heart failure
 Umbilical hernia can be observed for up to  age of 3 – 5 years old
 Associated with high risk of sudden cardiac death in dementia  Quetiapine (Seroquel)
 Must be given before endarterectomy  statin
 The most common source of chest pain in pediatrics  musculoskeletal
 Patient with legionella pneumonia presenting with hyponatremia attributed to SIADH but she is
asymptomatic, RX  fluid restriction
 Hepatitis B screening is NOT recommended for  all new born
 Vitamin B12 deficiency is associated with  high methylmalonic acid
 Hoarding disorder  anxiety and emotional distress if collected items are disposed of
 In primary syphilis the PRP test can become positive in  3 weeks
 Can be used to quit smoking after bupropion and varenicline  Nortripyline
 Bisphosphonate SE  atypical femoral shaft fracture
 Bisphosphonate can be used for the treatment of  hypercalcemia
 If IUCD is inserted after 7 days of LMP then  back up for 7 days
 Diabetic medication that increase the risk of UTI  SGLT2 inhibitor like canagliflozin (invokana)
 The 1st line therapy for chronic Achilles tendinopathy  eccentric strengthening exercise
 Celiac disease with IDA & chronic diarrhea are at risk for  osteoporosis (bone loss from ↓ vitamin
D+ calcium)
 Will lower complication and shorten hospital stay in severe pancreatitis  enteral feeding
 Initial investigation for endometriosis  TVUS
 Best investigation for endometriosis  laparoscopy with histology
 Infectious disease that can cause cardiomyopathy, heart failure, fatal cardiac arrhythmias 
American trypanosomiasis (Chagas disease)
 D recommendation means  moderate or high uncertainty that the service has no net benefit or
that the harms outweigh the benefit
 Severity of anorexia is measured via  BMI
 Can increase the risk of latent TB progressing into active Tb  lung cancer
 MVP with mitral regurgitation dental procedure prophylaxis  no need
 Can cause agranulocytosis  Methimazole (tapazole)
 Treating GDM will decrease the risk for  maternal preeclampsia
 Motor restlessness in patient on haloperidol is called  akathisia
 Bony abnormal growth in hard palate  torus palatinus (no further RX needed, it is benign)

14
Done by: Dr. Noor Al Jasim
 The best to diagnose vitamin D deficiency  25 – hydroxyvitamin D
 Can reduce the severity of erythema multiform (target lesions)  acyclovir (HSV)
 The only medication that can be used to treat depression in pediatrics  Fluoxetine (Prozac)
 Is a vector for bartonella Quintana which can cause feverm flu like SX in homeless people  lice
 Sport induce asthma with no relief of salbutamol before exercise  add Inhaled steroid

2016
 Has the greatest potential for over diagnosis  PSA
 Transient synovitis RX in pediatrics  ibuprofen
 The treatment of SVT that can be used acutely and over long time  CCB (verapamil)
 Fatigue with ovalocytes in peripheral smear  beta thalassemia minor treat (do Hb electrophoresis)
 ALS is associated with LMN + bulbar palsy can present as  asymmetric leg weakness
 Can be used for pain management in severe renal failure but not hepatic dysfunction  methadone
 Continuous prophylactic antibiotics in patients with moderate COPD  reduces exacerbations
 FACT: prostate is expected to be enlarged after TURP
 The most common cause of incontinence in elderly is  detrusor instability
 2nd generation antihistamine but causes sedation  Zyrtec
 Must be done after sport head trauma  physical and cognitive test
 Screening for lung ca  low dose non-contrast CT scan annually
 Dabigatran (pradaxa) antidote  Idaruaizumab
 Elective induction of labor should be done at  39 weeks GA
 Effective in preventing seizure of alcohol withdrawal  chlordiazepoxide
 Spirometer of PE  low DLCO and normal PFT
 Spirometer of ILD  low DLCO and restrictive pattern
 The best RX for alcohol relapse + renal disease + osteopenia  naltrexone
 Antidepressant that should be avoided in elderly  Paroxetine (anticholinergic effect)
 Autism screening should begin at age  18 – 24 months old
 The most common complication of page’s disease  hearing loss
 Lyme disease cardiac complication  heart block
 Bacterial vaginosis criteria  3 out of 4 of 1. Thin white homogenous discharge 2. Clue cells on
microscopic exam 3. pH > 4.5 4. Fishy odor 10% whiff test KOH
 Gout treatment for chronic stage 4 kidney disease  steroid
 The most common cause of medication related SE attributed to  anticoagulation
 3cm adrenal mass is most likely  adrenal adenoma ( >5cm is malignancy)
 Risk factor for uncomplicated cystitis  frequent sexual intercourse
 Can prevent intubation in ACEI related angioedema  bradykinin receptor antagonist
 Barrett’s esophagus should get endoscopy every  3 years
 Can cause bronchiolitis obliterans pneumonia  amiodarone
 STI screening should be screening in monogamous relationship  annually
 HSP can occur in adults, associated with  35% orchitis and testicular swelling
 OA 1st line RX  stretching and strengthening with physical activity
 Ankylosing spondylitis pain usually  improve with exercise and activity, worse at night, stiffness in
the morning
 abdominal CT is equal to = 400 CXR
 can prevent recurrent nephrolithiasis  2 L fluid/day + thiazide diuretics
 subacute thyroiditis  painful tender thyroid following URTI, RX  NSAIDs + steroids

15
Done by: Dr. Noor Al Jasim
 lab associated with von Willebrand disease  prolonged aPTT
 can falsely elevate HbA1c  IDA, ↑TG, ↑bilirubinemia, Renal failure, aplastic anemia, splenectomy
 patient with splenectomy are at risk of 50% mortality with sepsis they need  IV antibiotics
 the most common type of elderly abuse  financial exploitation
 not part of chronic fatigue syndrome  joint erythema
 elderly physiology  ↓renal flow, ↓cardiac output, ↑peripheral resistance, wider pulse pressure
 CURB 65
o Confusion
o BUN < 19
o RR > 30
o BP < 90/60
o Age > 65
 Antidepressant that can cause prolonged QT interval  Citalopram
 Prophylaxis for travelling diarrhea to east Asia  azithromycin (cover campylobacter)
 Prophylaxis for travelling diarrhea to Africa, south and central America  Cipro
 Phimosis can be physiological, paraphymosis is emergency
 Effective in preventing pressure ulcer  protein supplements
 To prevent IDA in exclusively breast feed term infant iron supplement started at  4 months
 Hyperlipidemia is more common in nephrotic syndrome than coagulopathy
 Symptom control rather than improving mortality in acute MI  nitroglycerin
 Preoperative test for valve replacement  gait speed test
 Required for the diagnosis of CLL  flow cytometry + immunophenotyping of peripheral blood
 Jersey finger  flexor digitorium profoundus rupture
 RF for SIDS  side sleeping and sharing bed
 To differentiate pneumonia and heart failure  BNP and procalcitonin level
 DM with tender scaly reddish-brownish with yellow deposit  necrobiosis
 Treatment of non-bullous impetigo  cephalexin (Keflex)
 Polymyalgia rheumatic RX  prednisolone 15 mg daily with slow taper
 Little league shoulder  proximal humeral epiphysitis
 Deterioration after control in DM patients is due to  renal disease
 Can increase mortality in smoker  beta carotene and vitamin E supplements
 Fluoride supplement should be started from the age of  6 months old
 SVT RX  vagal maneuver then adenosine then verapamil
 Drug that can reduce vitamin D level  phenytoin
 Can help in HTN RX  monitor home blood pressure reading
 Absolute contraindication to COCP  smoking 1 pack of ciegarettes/day

2017
 PCI is preferred over fibrinolysis if  Symptoms less than 12 hours and transfer less than 30 min
 Before starting HIV prophylaxis (Truvada) must document  HepB surface antibody and antigen
 Start Proscar (Finasteride) only if prostate enlarger and if PSA level is more than  1.5 ng/ml
 Dual antiplatelet therapy should be started after stent for at least  1 year
 OSA can cause  pulmonary HTN (other DDX COPD, heart failure)
 Bipolar patient that needs to gain weight  Quetiapine (Seroquel)
 Long wide protruding ears, elongated face, frontal bossing  Fragile X syndrome
 Ramsy hunt syndrome is caused by  varicella zoster virus, RX  steroid + acyclovir

16
Done by: Dr. Noor Al Jasim
 Diabetic neuropathy RX  1st lyrica (pregabalin) then TCA amitriptyline
 Contraindicated in serve’s disease  therapeutic ultrasound
 The best in preventing motion sickness  scopolamine (transdermal is better than oral)
 Normal pulmonary function test but low DLCO  chronic pulmonary embolism
 Prosthetic heart valve for prophylaxis for dental procedure but allergic to penicillin  clindamycin
 Carbamazepine electrolyte side effect  hyponatremia
 Can decrease sleep disturbance and nightmare  Prazosin (minipress)
 DDX of peripheral neuropathy  DM, hypothyroidism, nutritional deficiencies, chronic liver and
kidney disease, high alcohol, amiodarone, digoxin, statin
 The rate of failure for COCP  9%
 Direct observational therapy  decrease drug resistant Tb
 Local steroid provide long term improvement for  trigger finger
 11 year old healthy should be screened for  hyperlipidemia
 SSRI role in fibromyalgia  provide some pain reduction
 FACT: in order to diagnose ADHD in adults  SX need to present before the age of 12
 Vitamin D deficiency for diagnosis  25 - hydroxyvitamin D
 Vitamin D deficiency for monitoring  1, 25 - dihydroxyvitamin D
 Co-existing condition that will require higher dose of thyroxine to be given in a patient with
hypothyroidism  H/ pylori gastritis
 The best to predict likelihood of NSR after cardioversion in afib  the left atrium
 The best anticoagulation in cancer patients for DVT  LMWH Enoxaparin (Lovenox)
 Oppositional defiant disorder  1. Angry/irritable mood 2. Argumentative/defiant 3. Vindictiveness
4. Must be toward 1 person other than sibling 5. Serious aggression towards adults does NOT occur
 Can help the progression of ophthalmological graves’ disease  methimazole (Tapazole)
 To assess the usefulness of a test to either support or exclude DX of disease  likelihood ratio
 To aid the passage of kidney stone  alfa blocker (Tamsulosin) Flomax
 Contraindicated to the sue of Exentide  thyroid cancer and other MEN syndrome
 Indication for thrombolysis in PE  hypotension and not bilateral PE
 Iron supplement should be started in exclusively breast feed preterm infant at  1 month of age
 In Achilles tendinopathy  steroid injections are contraindicated as they can lead to rupture
 Can cause falsely elevated BNP  renal failure (high creatinine)
 Can cause falsely reduce BNP  obesity
 Elder than 65 years old and not previously vaccinated should get:
o PCV13 and after 12 months PPSV23 and herpes if not given at the age of 60
 Probiotics in children will  prevent antibiotics associated diarrhea
 Systematic sclerosis patient will have restrictive lung disease  interstitial lung disease
 The most important risk factor for domestic violence  gender!! :I
 The most likely type of polyp to become malignant  villous adenomas
 The best to be used for lower back pain without radicular symptom  cyclobenzaprine
 Isolated high ALP must do  GGT (to know bone or liver)
 Roseola infantum  can occur in 2 years old, first fever then rash, caused by HH6
 Otitis externa in children with ventilation tube  Cipro eardrops
 Must be done post sleeve gastrectomy  bone density scan in 2 years
 In need of iron supplement after gastric bypass surgery should be given via  IV
 Can cause thrombocytopenia  Zantac, stop it and repeat in 2 weeks
 Immigrant with chest pain suspected pericarditis most likely cause  Enterovirus infection

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Done by: Dr. Noor Al Jasim
 Indication for CXR  RR >24, Temp >100F, bloody sputum, focal consolidation, SOB, tachycardia
 6 years old with severe back pain awakening him from sleep is most likely  discitis
 Boxer fracture management  ulnar gutter splint
 Patellofemoral syndrome  anterior knee pain, more common in female, more going down stairs
 Confirm the diagnosis of microscopic colitis  biopsy of the colon

2018
 The best to confirm Legionella  urine legionella pneumophila antigen
 Increase the risk for developmental dysplasia of the hip  breech presentation + family HX
 If parents refused vaccine  have them sign refusal to vaccinate form
 Prepatellar bursitis RX  RICE
 Absolute contraindication to fibrinolysis  ischemic stroke (in the past 3 monthsunless diagnosed
4.5 hours back)
 Increase the risk of afib  > 1 alcoholic beverage per day
 To detect response to RX in IDA  retics count in 1-2 weeks
 RX of chronic urticaria  1st H1 blocker like loratidine then H2 blocker like zantac
 Shell fish allergy is not a contraindication for oral and IV contrast study
 Suspected appendicitis in pediatrics  US over CT
 The best anti DM medication to improve cardiovascular outcome  Liraglutide (Victoza) GLP1
 2 years old with SCD better to screen her with  transcranial Doppler ultrasound
 Fetal alcohol syndrome  thin upper lip, clinodactyly, flat philtrum
 Otitis media with effusion in pediatrics  follow up after 3 months, no treatment necessary
 Paroxetine is only for breast feeding, not good for elderly. No no Papa
 Fluoxetine for pregnant and children and elderly
 Silicosis from sand and glass (stone cutter occupation)
 Double contrast is a must for bowel imaging
 Best to treat dehydration in pediatrics  half strength apple juice and food on demand
 HOCM (murmur intensify with Valsalva maneuver) RX  beta blocker
 The best to control SX of aggressiveness & agitation in elderly with dementia  Aripiprazole (abilify)
 Subclinical hyperthyroidism should be tested for  osteoporosis with DXA scan
 BPV confirmed with  nystagmus when vertigo occur on Dix-Hallpike maneuver
 The herbal that is associated with high risk for drug interaction  St. John’s wort
 Fracture involving distal radius  sugar tong splint
 Wood lamp test :
o Coal pink  Erythrsema
o Pale blue under florescence  pseudomonas infection
o Bright yellow  Tina infection
o Totally white  Vitligio
o Beefy red  streptococcal infection
 CI in bariatric surgery  NSAIDs

18
Done by: Dr. Noor Al Jasim
 Shingrinx recombinant zoster vaccine is better efficacy than live zoster vaccine (Zostrax)
 The only evidence based treatment for autism intensive behavioral therapy
 The worst combination for accidental overdose  opiates (oxycodone) + benzodiazepine
(lorazepam)
 The most common cause of chronic cough in adults  PND, RX  intranasal steroid
 Lactulose in not recommended for IBS cause it increase flactuance (broken down by the flora)
 Osmotic laxatives are not recommended for elderly and renal patients  electrolytes imbalance
 Suspected biceps tendon rupture must MRI for diagnosis (clinically unreliable)
 Immediate release oxycodone peak effect  1 hour after it is given (2 doses should be 1 hour apart)
 If PO2 < 60 then u give supplemental oxygen to decrease mortality
 OSA choice of anti HTN  spironolactone it will treat HTN + pharyngeal edema
 Suspected little league syndrome imaging  plain x-ray of shoulder
 Malignancy associated with hereditary hemochromatosis  hepatocellular carcinoma
 Rodent exposure + GI symptoms + gram negative rods  Yersinia pestis
 The best evaluation of fibromuscular dysplasia in HTN patients  MR angio of renal arteries
 The greatest risk factor of osteoarthritis in older adults  obesity
 Elderly with asymptomatic bacteriuria  no RX (only in pregnancy)
 The best to diagnose mesenteric ischemia  CT angio
 Should be checked before starting or adjusting the dose of noval anticoagulant  renal function test
 The most effective medication to maintain alcohol abstinence  acamprosate
 Marfan syndrome associated with  aortic insufficiency
 Smoker with hemoptysis  CXR then CT scan
 Constant pain in the 5th metatarsal need  MRI of foot (maybe stress fracture)
 Atypical and typical antipsychotics when used in dementia can  increase risk of mortality
 DM medication that can cause weight gain  sulfonylurea (amaryl)
 Facial rash that affect the nasolabial fold and around the mouth, scaly and itching  sebherroic
dermatitis and the treatment is  topical antifungal and steroid
 FACT: statin can reduce mortality of cardiovascular disease as well as preoperatively
 Venous stasis ulceration treatment  compression therapy
 The most reliable method to protect children from lead toxicity  eliminate lead sources
 Avoid using gadolinium contrast if EGFR  less than 30ml/min
 Pulseless VT = Vfib , management  defibrillation
 Inhaled medication that reduce exacerbation & hospitalization in COPD  Tiotropium
 Can improve psuedofolliculitis rash  shaving with electrical clippers
 For acute and chronic management of anticoagulation in malignancy  Enoxaparin
 If AST: ALT ratio > 2:1  alcoholic liver disease
 Carpal tunnel syndrome cause  decrease sensation over thumb, index and middle finger
 Warfarin should be stopped 5 days preop and restarted 12-24 hours preop unless complications
 Increase fertility in PCOS  Letrozole (better than clomiphene)

19
Done by: Dr. Noor Al Jasim
 Lesser Thelat sign  abrupt multiple seborrheic dermatitis and is associated with underlying
malignancy especially stomach adenocarcinoma, next step  upper and lower endoscopy
 RX of rocky mountain spotted fever  doxycycline
 Anti DM medications that should NOT be given if h/o pancreatitis  DPP41 and GLP1
 Can cause falsely lower level of HbA1c  hemolytic anemia
 The most common cause of neonatal sepsis  GBS + Ecoli
 The most common cause of tinnitus  sensorineural hearing loss
 Reddish blue papules on penis, no other SX  angiokeratomas
 Chronic 10 year duration tension type headache RX  amitriptyline
 Rate of IV fluid in sepsis  3000 ml over 3hours
 Indicates of MRI instead of mammogram  past h/o chest radiation for Hodgkins lymphoma
 Decrease the risk of dosing error in pediatrics  use of oral syringe
 Depression and mania = bipolar 1 the medication that is CI to be used solo  Fluoxetine (Prozac)
 Can be used for stress related opiod craving in patient on buprenorphine  clonidine
 RBC casts in urine is pathogenomic for  acute glomerulonephritis
 patient in need of both PCV13 + PPSV23 if he has  chronic renal failure
 bell’s palsy RX  tapering dose of steroid + valacyclovir
 the test to confirm Cushing syndrome  urinary free cortisol
 suggestive of duschan muscular dystrophy in 18 month old  head lag when sitting up
 associated with oligohydramnios  posterior urethral valve
 mild – moderate cellulitis treatment to cover MRSA  trimethoprim/sulfamethoxazole + cephalexin
 strabismus in children should be referred to ophthalmology if not resolved at  6 months of age
 refer scoliosis to orthopedics if  cobb angle is more than 20
 RX of falling asleep and staying asleep  Eszopiclone (Lunesta)
 RX of osteopenia is indicated if the 10 year fracture risk reached 20%
 Hyperthyroidism RX in pregnancy  PTU
 PO medication for rosacea  doxycycline
 The best RX for vaginal prolapse in 75 years old sexually active  ring pessary
 Stress # in 2nd metatarsal  no weight bearing few days, walking boot rigid soled shoe for 4-6 weeks
 Crohns disease with cramping diarrhea following resecting the terminal ileum, RX  cholestyramine
 PTSD RX  SSRI or SNRI next step Prazosin (minipress)
 Improve survival in NSTEMI already on aspirin, ACEI and BB  statin
 Acne appearing at what age that will need testing for underlying endocrine disorder  5 years old
 Procalcitonin level less than 0.1 means  less likely pneumonia
 Precocious puberty if penile enlargement before  9 years old
 Donepezil ECG changes include  bradycardia and prolonged PR intervals
 Valporic acid side effects  high ammonia level
 Contraindication to starting testosterone  polycythemia
 De Quervian’s RX  immobilization in thumb spica splint + NSAID for 1 – 4 weeks

20
Done by: Dr. Noor Al Jasim