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QId: 7183 Medicine - Biostatistics & Epidemiology

A cohort study is a group of people who are similar in most ways but are divided by the presence or
absence of a certain risk factor. Pts are then followed for a period of time and the incidence of selected end
points is compared between the groups. Cohort studies can be used to calculate relative risk. RR is the
incidence in individuals with the risk factor divided by the incidence in those without it.

QId: 7071 Surgery - Cardiovascular System

Indication for surgical repair of AAA:

-presence of symptoms regardless of size (severe abd pain or back pain)
-size greather than 2x the diameter of the normal aortic segment
-size greater or equat to 5.5cm
-expansion greater tan 0.5cm over 6 months
*If doe snot meet above criteria evaluate with US or CT at regular intervals every 6mo to 2 years

QId: 7180 Medicine - Cardiovascular System

In pts with Afib/Aflutter of unknown duration or >48 hours >3 wks of anticoagulatioon is required prior to
cardiac ablation or attempted pharmacologic or electrical cardioversion.

QId: 7102 Medicine - Dermatology

Erythema multiforme is characterized by erythematous plaques with central clearin lesions that usualy
begin on extremities; >90% of cases are caused by underlying infection; herpes simplex is the leading
cause. Do not confuse with erythema marginatum which can develop in pts with untreated strep pyogenes
pharyngitis. These rlesions are pink or faintly red with central clearing but usually begins in the trunk and
not on extremities. Erythema marginatum in rheumatic fever can appear, disappear and reappear within
hours and is halmark or rheumatic fever. Rheumatic fever is also accompanied by migratory arthritis,
carditis, subcutaneous nodules and Sydenham chorea.

QId: 7106 Medicine - Dermatology

Lichen planus 4P's: pruritic, planar, polygonal and purple. Wickham striae are white, lacelike patters that
are sometime seen on the surface of these papules.

QId: 7172 Medicine - Dermatology

Carbuncle (infection of multiple hair follicles) should be treated empirically with abx active against
MRSA (clindamycin, tmp-smx or doxycycline. I&D is also warranted in most cases. A furuncle is
infection of a single hair follicle.

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QId: 7097 Medicine - Endocrine, Diabetes & Metabolism

Primary hyperparathyroidism is the most common cause of hypercalcemia. Parathyroidectomy is

recommended for pts who have symptomatic hypercalcemia, complications (osteoporosis t-score <2.5,
fractures, neohrolithiasis, CKD), increased risk of complicationa (calcium >1mg/dl above normal, urinary
Ca >400) or age <50. Those who do not require surgery should have regular f/u with serum Ca, creatinine
and DXA scan. PTH excess leads to hypercalcemia, calciuria, hypophosphatemia and hyperchloremia.

QId: 7124 Medicine - Gastrointestinal & Nutrition

Liver mass in pt with hepB and clinically evident chronic liver disease is highly suggestive of HCC, which
arises from hepatocytes. Serum alpha phetoprotein can be normal in up to 40% of pts with small tumors.

QId: 7088 Surgery - Gastrointestinal & Nutrition

Pts with chronic anticoagulation are at risk for bleeding. Retroperitoneal hemorrhage is rare but can occur
with mild trauma or without trauma in AC pts. Pts present with severe lower quadrant abdominal pain or
back pain. PE will show positive psoas sign (pain worsens with active flexion of thigh). An abdominal CT
scan is the initial diagnostic test of choice.

QId: 7135 Surgery - Gastrointestinal & Nutrition

Treatment for AC reversal in warfarin is 10mg of vit K IV slow infusion + 2-3 units of FFP if indicated.
Protamine sulfate is for pts who bleed while on heparin.

QId: 7118 Surgery - Hematology & Oncology

Surveillance US for AAA 3-4 cm is every 2-3 years. Aneurysms >4cm require monitoring every 6-12
months.

QId: 7037 Surgery - Infectious Diseases

Human bites require antibiotic prophylaxis with amoxicillin-calvulanate as 1st line. Clinda and
ciprofloxacin used in combination for prophylaxis pts who are penicillin allergic.

QId: 7091 Medicine - Nervous System

Prophylactic tx fro migraine is recommended for pts wtih >2 migraine headache days/month. First line are
b-blockers (metoprolol), TCA's (amytriptyline) and antivconvulsants (valproate). Dopamine receptor
antagonists (metoclopramide, chlorpromazine) can be used in acute treatments for nausea, vomiting and
pain; they are not indicated for prevention. Ergotamine preparations can be used to abort a migraine
however they are not used for prophylaxis. NSAID's and triptans(SSRI's) can also be used acutely but not
typically used for prophylaxis.

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QId: 7077 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

Remember that anti-Rh antibody titers in a ant-Rh negative mother means she has already undergone
alloimunization; administering anti-D immune globulin for second pregnancy will not be effective at
preventing fetal complications. Rhogam needs to be given in first pregnancy of Rh negative mother and
Rh + father to prevent alloimunization. Rising Ab titer is concerning for risk of hemolytic disease and
should prompt evaluation for anemia and hydrops fetalis. The Anti-D immune globulin is given at 28wks
in Rh negative mother and again <72 hours after delivery if the baby is Rh positive.

QId: 7128 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium

Standard prenatal laboratory panel includes:

-Rh type and antibody (Coombs)
-Hgb, Hct and MCV
-Rubella and Variclla serology
-HIV, Hep & syphillis
-Chlamydia nucleic acid amplification
-Urinalysis and Urine culture
-Guidelines based Pap
-Additional tests based in risk factors and age

QId: 7063 Psychiatry - Psychiatric/Behavioral & Substance Abuse

Before prescribing antidepressants therapy all pts with MDD should be screened for hx of manic or
hypomanic episodes to rule out bipolar disorder. All antidepressants in monotherapy can induce
hypomanic or manic episodes.

QId: 7049 Medicine - Renal, Urinary Systems & Electrolytes

Most diuretics (thiazide, furosemide) decrease fractional excretion of urate and should be avoided when
possible in pts with gout. ARB (losartan) has ild uricosuric effect and is effective as 1st line treatment for
hypertension in pts with goud. If additional antihypertensive is needed, Ca channel blockers (amlodipine)
is safe in gout.

B-blockers are not recommended as 1st line for tx of HTN and are associated with increased risk of gout
flare.

Hydralazine is used for HTN during pregnancy and management of heart failure (with isosorbide) in
African American pts. Otherwise they are rarely used in routine management of HTN and can have reflex
tachycardia.

QId: 7107 Medicine - Rheumatology/Orthopedics & Sports

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Low back pain due to medically serious diagnosis is present in <5% of cases, treat with NSAIDs & close
observation. Apart from Xray, consider MRI if "red flags" such as hx of cancer, weight loss, pain at night,
urinary symptoms, fever, neurologic deficits or refractory pain after several weeks of conservative
management.

QId: 7059 Medicine - Social Sciences (Ethics/Legal/Professional)

Criteria for decision making capacity includes 3C's: Comprehension, Consequences and Choice. Even pts
with cognitive impairment (intellectual disability, mild dementia, or substance abuse) are assumed to have
capacity and can make decisions regarding treatment until proven otherwise.

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