br02052026

​board review Feb 5th, 2026

By Frank Moskos

Why did we miss this? some common disconnects. 

Test taking style themes Content based themes

1. second guessed myself 1. local vs national standard

2. misread question 2. regency bias

3. missed key word or setting 3. emergent vs continuity setting 

4. answered too quickly 4. weaker in some subject areas

5. misunderstood testing point 5. information out of date. 

6. other 6. other.

Multiple Choice

44. A 58-year-old female with type 2 diabetes controlled on metformin recently underwent bariatric surgery. Today, she reports feeling off balance and having a burning sensation in her bilateral hands and feet that is worse at night. She reports difficulty ambulating and has fallen several times over the past few weeks. She has intermittent nausea, vomiting, and confusion, and reports aches and pains all over. A physical examination is significant for absent patellar and Achilles reflexes. Her strength is 4/5 in the bilateral lower extremities with decreased pinprick sensation.

    Which one of the following is the most likely diagnosis?

• 1. A)  Diabetic peripheral neuropathy

• 1. B)  Lyme disease

• 1. C)  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

• 1. D)  Secondary syphilis

• 1. E)  Vitamin B1 deficiency (beriberi)

ANSWER: E

This patient presents with a symmetrical peripheral neuropathy with sensory and motor components that are characteristic of beriberi caused by vitamin B1 deficiency. Risk factors include alcohol use, bariatric surgery, older age, diabetes mellitus, and HIV infection. Severe thiamine deficiency can lead to heart failure. Blood and urine tests for thiamine levels are recommended to confirm the diagnosis.

Diabetic peripheral neuropathy usually presents as a symmetric polyneuropathy, but it does not usually involve motor components, except in severe cases. Neurologic manifestations of Lyme disease include meningitis, facial nerve palsy, radiculoneuritis with radicular pain in a dermatomal distribution with accompanied weakness, sensory deficits, abnormal reflexes, other cranial neuropathies, and Lyme encephalomyelitis. Peripheral neuropathy is rare with Lyme disease and typically presents as a mononeuropathy, not a polyneuropathy.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) typically occurs after an acute infection, presenting with symptoms such as severe fatigue, sleep changes, and cognitive changes that are exacerbated by physical activity. ME/CFS is not associated with peripheral neuropathy. Secondary syphilis typically presents with a rash and constitutional symptoms. Neurologic symptoms associated with secondary syphilis include ocular symptoms and otosyphilis with vertigo, tinnitus, and hearing loss. Secondary syphilis is not associated with peripheral neuropathy.
question stats: 

our % right: 74

national % right: 83

pgy1: 5

pgy2: 8

pgy3: 7

so, why did i miss this?
didn't think about vitamin deficiency in a bariatric surgery patient....

Dry beriberi is the development of a symmetrical peripheral neuropathy characterized by both sensory and motor impairments, mostly of the distal extremities. Wet beriberi includes signs of cardiac involvement with cardiomegaly, cardiomyopathy, heart failure, peripheral edema, and tachycardia, in addition to neuropathy

Beriberi and Wernicke-Korsakoff syndrome have been reported as acute and chronic complications of weight loss surgery. Several of the case reports have been in adolescents, but whether this nutritional complication is more common in the adolescent age group as compared with adults undergoing weight loss surgery has not been established.

Multiple Choice

46. A 76-year-old female with a past medical history of hypertension and major depressive disorder presents because of acute right knee pain that began after she sustained a mechanical fall and landed on her knee while taking a walk near her house yesterday. She was able to walk home without difficulty. She applied ice to the area after the fall, but her knee was more painful this morning. When asked to point to the pain, she points to an area lateral to the inferior patella.

    Examination of the knee reveals no redness or swelling but minor warmth over the anterior knee. Lower extremity sensation is intact. The patient has full range of motion with pain. There is no tenderness of the patella or the fibular head with palpation. Provocative testing including an Apley grind test, a McMurray test, a Lachman test, and anterior and posterior drawer tests is negative.

    Which one of the following would be the most appropriate next step to aid in diagnosis?

• 1. A)  No further testing or imaging

• 1. B)  Ultrasonography

• 1. C)  Radiography

• 1. D)  MRI

• 1. E)  Arthrocentesis with culture and Gram stain

ANSWER: C

According to the Ottawa knee rules, a well-validated tool used to limit unnecessary radiography, a knee x-ray is indicated in this patient to rule out fracture because she is ≥55 years of age. Radiography is currently the preferred modality over ultrasonography for diagnosing a fracture in an adult. Because ligament and meniscal testing is negative, MRI is not indicated. Arthrocentesis with culture and Gram stain would be indicated if the history and physical examination suggest an infection of the joint space.
question stats: 

our % right: 19

national % right: 33

pgy1: 1

pgy2: 3

pgy3: 1

so, why did i miss this?
didn't think about your ottowa knee rules

The differential diagnosis for acute knee pain following trauma associated with an effusion includes the following injuries

Common:

●Medial or lateral collateral ligament tear

●Anterior cruciate ligament tear

●Meniscus tear

●Patellar dislocation or significant subluxation

●Patellar tendon tear

●Intra-articular fracture

●Osteochondral injury or defect

Less common:

●Bone contusion

●Posterolateral corner injury

●Posterior cruciate ligament tear

●Quadriceps tendon tear

●Fibular head or neck fracture

●Patella fracture

●Knee (tibiofemoral) dislocation

When to use?
The Ottawa Knee Rules should be applied to all patients aged 2 and older with knee pain/tenderness in the setting of trauma.

Pearls/Pittfalls:
The Ottawa Knee Rules were derived to aid in the efficient use of radiography in acute knee injuries.

Rules have been prospectively validated on multiple occasions in different populations and in both children and adults.

Numerous studies found sensitivities for the Ottawa Knee Rules of 98-100% for clinically significant knee fractures. One study did find a sensitivity of just 86%.

Specificities for the Ottawa Knee Rules typically range from 19%-50%, though the rule is not designed/intended for specific diagnosis.

When used appropriately, the amount of knee x-rays obtained can be reduced by around 20-30%.

The Ottawa Knee Rules are useful in ruling out fracture (high sensitivity) when negative, but poor for ruling in fractures (many false positives).

Tips from the creators at University of Ottawa:

Tenderness of patella is significant only if an isolated finding.

Use only for injuries <7 days.

“Bearing weight” counts even if the patient limps.

Precautions from the creators at University of Ottawa:

Clinical judgment should prevail if examination is ureliable:

Intoxication., Uncooperative patient., Distracting painful injuries., Diminished sensation in legs., Always provide written instructions.,

Encourage follow-up in 5-7 days if pain and ability to walk is not better.

Multiple Choice

46. A 31-year-old gravida 3 para 2 at 8 weeks' gestation presents to the urgent care clinic because of a 2-day history of headache and fever. This morning she removed an engorged tick from her leg. On examination she is ill appearing but alert and interactive. An HEENT examination is normal and there is no pain with neck flexion. A cardiopulmonary examination is normal. There is no rash. You suspect Rocky Mountain spotted fever.

    In addition to supportive care, which one of the following would be the most appropriate treatment?

• 1. A)  No additional treatment

• 1. B)  Amoxicillin

• 1. C)  Chloramphenicol

• 1. D)  Doxycycline

• 1. E)  Erythromycin

ANSWER: D

Doxycycline is the recommended treatment for all individuals with presumed Rocky Mountain spotted fever (RMSF). RMSF can be fatal, so testing for the condition is not recommended because it would delay treatment. Short courses (5–10 days) of doxycycline have been shown to be safe in children and pregnant persons. Inpatient treatment with rapid desensitization is recommended for individuals with a true allergy to doxycycline. Chloramphenicol is another treatment option for RMSF, but it is associated with a higher risk for death than doxycycline. There is no role for amoxicillin or erythromycin in the treatment of RMSF.
question stats: 

our % right: 56

national % right: 43

pgy1: 6

pgy2: 4

pgy3: 5

so, why did i miss this?
didn't recognize RMSF..... you need to know this.....
didn't read your sanford guide.
also, recent studies have shown that doxy does not stain teeth.

The distinction between tetracycline derivatives is clinically significant. While five of 18 studies on tetracycline described a dose-response relationship between exposure to tetracycline doses >20 mg/kg per day and dental staining, newer tetracycline formulations (doxycycline and minocycline) at currently recommended dosages showed no evidence of adverse effects on dental health.[4]This finding challenges the class-wide contraindication that has historically been applied to all tetracyclines during pregnancy.

The CDC's expert review on tickborne rickettsial diseases acknowledges this evidence gap, noting that the risk for cosmetic staining of primary teeth by doxycycline could not be determined because of limited data.[5] While use of tetracycline-class drugs has generally been contraindicated during pregnancy due to concerns about musculoskeletal development and tooth staining, these adverse effects were observed specifically with tetracycline and older derivatives—not necessarily with doxycycline.

Multiple Choice

A 53-year-old female with no significant past medical history presents to the emergency department with fatigue, pruritus, and right upper quadrant discomfort. A physical examination reveals mild hepatomegaly.

Laboratory Findings

Alkaline phosphatase
AST
Total bilirubin Antimitochondrial antibodies

450 U/L (N 44–147) 70 U/L (N 10–40)
1.5 mg/dL (N 0.1–1.2) positive

Which one of the following is the most likely diagnosis?

• 1. A)  Autoimmune hepatitis

• 1. B)  Drug-induced liver injury

• 1. C)  Metabolic dysfunction–associated steatotic liver disease (MASLD) (nonalcoholic fatty liver disease)

• 1. D)  Primary biliary cholangitis

• 1. E)  Primary sclerosing cholangitis

ANSWER: D

Primary biliary cholangitis is characterized by chronic cholestasis, positive antimitochondrial antibodies (AMA), and elevated alkaline phosphatase (ALP). The American Association for the Study of Liver Diseases (AASLD) guidelines state that the diagnosis of primary biliary cholangitis can be established with the presence of at least 2 of the following: biochemical evidence of cholestasis (elevated ALP), presence of AMA, and histopathologic evidence of nonsuppurative destructive cholangitis. Elevated AMA is particularly helpful as it is found in >95% of cases of primary biliary cholangitis.

Autoimmune hepatitis usually presents with elevated aminotransferases and positive autoantibodies such as antinuclear antibodies or anti–smooth muscle antibodies, rather than AMA. It is not primarily a cholestatic disease and elevated ALP is typically not the predominant finding. Depending on the instigating agent, drug-induced liver injury can present with a variety of liver enzyme abnormalities; however, the presence of positive AMA and the chronicity of symptoms make it less likely in this patient scenario. Metabolic dysfunction–associated steatotic liver disease (MASLD) (formerly known as nonalcoholic fatty liver disease) typically presents with elevated aminotransferases and is associated with metabolic syndrome. It is not characterized by cholestasis or positive AMA. Primary sclerosing cholangitis typically presents with cholestatic liver enzyme abnormalities and is often associated with inflammatory bowel disease. It is diagnosed based on characteristic imaging findings of bile duct strictures using MRI cholangiography or endoscopic retrograde cholangiopancreatography. Positive AMA is rarely found in primary sclerosing cholangitis.
question stats: 

our % right: 67

national % right: 59

pgy1: 8

pgy2: 5

pgy3: 5

so, why did i miss this?
overlooked the antibodies
didn't recognize the pattern with PBC....

Antimitochondrial antibodies (AMA) demonstrate a pooled sensitivity of 84% (95% CI 77-90%) and specificity of 98% (95% CI 96-99%) for the diagnosis of primary biliary cholangitis (PBC), based on a 2023 meta-analysis of 24 studies.[1] These values translate to a positive likelihood ratio of 42.2 and negative likelihood ratio of 0.16, confirming AMA as a highly specific and moderately sensitive diagnostic marker

Clinical context matters for interpretation. The American Association for the Study of Liver Diseases notes that AMA is found in 95% of PBC patients, with approximately 5-10% being AMA-negative or having only low titers (≤1:80) by immunofluorescence.[3] A recent JAMA review confirms that the combination of unexplained cholestasis and positive AMA (≥1:20 by immunofluorescence or positive ELISA) has a 95% positive predictive value for histologic diagnosis of PBC.

Multiple Choice

49. A generally healthy 28-year-old female presents to your office because she is concerned about changes in her mood. For the last few months she has been intermittently irritable and unable to sit still. She has had some weight loss, is not sleeping well, and feels fatigued. She has been working extra hours to get ahead of her office deadlines. She has maxed out her credit card and repeatedly cheated on her husband, who filed for divorce 2 weeks ago. She now feels depressed and anxious, and has considered suicide but does not have suicidal ideations today. She says that she has had similar episodes in the past. Her father left when she was an infant and her mother is incarcerated, and the patient is unsure of their medical history.

    Today the patient's vital signs, a CBC, a comprehensive metabolic panel, and TSH and vitamin B12 levels are unremarkable. A urine pregnancy test and drug screen are negative. She is alert and oriented during the office visit.

    Which one of the following would be the most appropriate therapy at this time?

• 1. A)  Bupropion

• 1. B)  Paroxetine (Paxil)

• 1. C)  Quetiapine (Seroquel)

• 1. D)  Sertraline (Zoloft)

• 1. E)  Electroconvulsive therapy

ANSWER: C

This patient has features of bipolar disorder, a mental health condition affecting >1% of the world's population. The DSM-5 criteria can be used to suggest a prognosis and determine episode severity. Patients with bipolar disorder have a high suicide rate, so proper diagnosis and prompt treatment are important. The risk of relapse increases in patients who are untreated. Treatment improves prognosis and medications are the mainstay of therapy. FDA-approved medications for the treatment of bipolar disorder include lithium, anticonvulsants, and atypical antipsychotics such as quetiapine.

Although this patient has symptoms of depression, monotherapy with an antidepressant is contraindicated in patients with mixed features, manic episodes, or bipolar I disorder. Augmenting therapies such as omega-3 fatty acids, light therapy, ketamine, and probiotics may be helpful but current evidence is insufficient. Cognitive behavioral therapy, exercise, and nutrition have been shown to be beneficial as well. Electroconvulsive therapy can be an effective treatment for psychotic depression, mania, refractory illness, catatonia, acute psychosis, and suicidal behavior. However, pharmacotherapy is the first-line treatment for bipolar disorder.
question stats: 

our % right: 78

national % right: 78

pgy1: 6

pgy2: 7

pgy3: 8

so, why did i miss this?
didn't recognize bipolar or forgot its treatment....

Most Effective Agents (Lowest NNT)

The olanzapine-fluoxetine combination demonstrates the lowest NNT of 4, making it the most efficacious treatment based on response rates (56.7% vs 34.7% placebo). However, this comes at the cost of substantial weight gain, with 30.3% of patients experiencing ≥7% weight gain compared to 1.1% with placebo.

Quetiapine monotherapy has an NNT of 6 (49% response rate), supported by consistent evidence across 5 trials. Quetiapine also uniquely demonstrated superiority over placebo in reducing treatment-emergent affective switches.

Other Atypical Antipsychotics

Lurasidone: NNT of 5 for monotherapy, NNT of 7 as adjunctive therapy (48.5% response rate). Lurasidone offers enhanced tolerability with NNH of 15 for akathisia (monotherapy) and NNH of 16 for nausea (adjunctive therapy).

Cariprazine: NNT of approximately 5-7 (44.5% response rate), with efficacy demonstrated in both monotherapy and adjunctive settings.

Lumateperone: response rate of 42.4%, though specific NNT not reported in the references.

Olanzapine monotherapy: NNT of 11.3 (44.3% response rate), but poorly tolerated with NNH ≤4.18 for metabolic side effects.

Mood Stabilizers

Lamotrigine: NNT of 12 (44.4% response rate). While less efficacious than antipsychotics, lamotrigine offers superior tolerability with double-digit NNHs, making it useful in low-urgency situations.

Valproate/Divalproex: NNT of approximately 5-6 based on pooled analyses, though tolerability concerns exist with NNH <10 for carbamazepine and valproate.

Lithium: appears poorly effective but well tolerated, though remains inadequately tested with only one trial available. The response rate was 38.1%, not significantly better than placebo (34.7%).

Multiple Choice

49. A 23-year-old female presents for IUD removal because she wants to conceive. She has never been pregnant, is in good health, and takes no medications. Her blood pressure is normal and her BMI is 33 kg/m2.

    Which one of the following should you recommend regarding aspirin prophylaxis for preeclampsia?

• 1. A)  No aspirin as she does not meet criteria

• 1. B)  Aspirin for 1–3 months prior to conception

• 1. C)  Aspirin at 12 weeks' gestation

• 1. D)  Aspirin if her blood pressure during pregnancy is >135/80 mm Hg

ANSWER: C

The U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists recommend aspirin prophylaxis for pregnant patients who are at increased risk for preeclampsia. Indications include 1 or more high-risk factors or 2 or more moderate-risk factors.

High-risk factors include a history of preeclampsia, multifetal gestation, kidney disease, autoimmune disease, type 1 or type 2 diabetes, and chronic hypertension. Moderate-risk factors include first pregnancy, maternal age ≥35 years, BMI >30 kg/m2, family history of preeclampsia, sociodemographic characteristics, and personal history factors.

This patient is nulliparous and has a pre-pregnancy BMI >30 kg/m2, giving her 2 moderate- risk factors. The recommended aspirin prophylaxis for preeclampsia is 81 mg per day and should be started at 12 weeks' gestation.

Low-dose aspirin has been shown to decrease the frequency of preeclampsia as well as other adverse pregnancy outcomes such as intrauterine growth restriction and preterm birth. It also has favorable fetal and maternal safety profiles.
question stats: 

our % right: 41

national % right: 39

pgy1: 4

pgy2: 4

pgy3: 3

so, why did i miss this?
were not aware of USPSTF guideline on preeclampsia prevention

LISTEN TO THE FEBRUARY 2026 PCRAP/HIPPOMD episode as they discuss this at length!!!!!!!

Multiple Choice

51. A 74-year-old female presents to your office for follow-up of cardioembolic stroke 1 day after being discharged from the hospital. She presented to the hospital with acute left-sided hand and face weakness. An evaluation in the hospital revealed new atrial fibrillation, mild mitral regurgitation, and a small right-sided cerebral infarction. Cardioembolic stroke was diagnosed. She was discharged 48 hours later after her left-sided weakness had almost completely resolved.

    Which one of the following therapeutic options is preferred for this patient?

• 1. A)  Apixaban (Eliquis)

• 1. B)  Aspirin

• 1. C)  Clopidogrel (Plavix)

• 1. D)  Warfarin

• 1. E)  Aspirin plus clopidogrel

ANSWER: A

This patient presents with a recent history of cardioembolic stroke. In patients who have a TIA or small cardioembolic stroke and nonvalvular atrial fibrillation, guidelines recommend starting anticoagulation without antiplatelet agents 2–14 days after the event. Nonvalvular atrial fibrillation is defined by the lack of moderate to severe mitral stenosis or a mechanical heart valve; direct-acting oral anticoagulants are preferred to warfarin in these patients. The 2024 Optimal Timing of Anticoagulation After Acute Ischaemic Stroke (OPTIMAS) trial confirmed the safety of starting anticoagulation within 4 days of a stroke. In patients with larger strokes that may be at high risk for hemorrhagic conversion, initiating anticoagulation may be delayed to 14 days.
question stats: 

our % right: 63

national % right: 67

pgy1: 6

pgy2: 6

pgy3: 5

so, why did i miss this?
thinking more ischemic and not afib/embolic
overthought the timing and delaying initiation.....

The 2024 OPTIMAS trial demonstrated that early direct oral anticoagulant (DOAC) initiation within 4 days after acute ischemic stroke with atrial fibrillation was non-inferior to delayed initiation (7-14 days) for the composite outcome of recurrent ischemic stroke, symptomatic intracranial hemorrhage, unclassifiable stroke, or systemic embolism at 90 days.

Primary Findings

The trial randomized 3,621 patients at 100 UK hospitals between July 2019 and January 2024. The primary outcome occurred in 59 (3.3%) patients in both the early and delayed groups (adjusted risk difference 0.000, 95% CI -0.011 to 0.012). The upper limit of the 95% CI was less than the prespecified non-inferiority margin of 2 percentage points (p_{non-inferiority}=0.0003), establishing non-inferiority. However, superiority was not demonstrated (p_superiority=0.96).

Secondary Outcomes

Recurrent ischemic stroke occurred in 14 (1.4%) patients in the early group versus 25 (2.5%) in the delayed group (OR 0.57, 95% CI 0.29-1.07), suggesting a numerical trend favoring early initiation.[1] Symptomatic intracranial hemorrhage was rare and similar between groups: 11 (0.6%) with early initiation versus 12 (0.7%) with delayed initiation (adjusted risk difference 0.001, 95% CI -0.004 to 0.006; p=0.78).

Key Subgroups

The trial included 528 (14.6%) patients with moderate-to-severe stroke (NIHSS >10 at randomization), a population of particular concern for intracranial hemorrhage risk. Importantly, there was no evidence of heterogeneity in treatment effect based on stroke severity, use of acute reperfusion treatments (thrombolysis or thrombectomy), or pre-existing anticoagulation use

Multiple Choice

51. A 75-year-old female with an ST-elevation myocardial infarction (STEMI) diagnosed in the emergency department has been admitted to your service. She underwent a percutaneous coronary intervention with a drug-eluting stent to the circumflex artery and had been recovering well until she developed acute shortness of breath on the fourth day of hospitalization. Today, her vital signs reveal a blood pressure of 91/55 mm Hg, a heart rate of 110 beats/min, and an oxygen saturation of 89% on room air. On physical examination, the patient appears moderately distressed and has no jugular venous pulse. Auscultation reveals a regular rate, normal S1 and S2, and a systolic murmur over the mitral post. Crackles are heard in all lung fields. There is no lower extremity edema.

    Which one of the following is the likely etiology of this condition?

• 1. A)  Cardiac tamponade

• 1. B)  Papillary muscle rupture

• 1. C)  Pericarditis

• 1. D)  Pulmonary embolism

• 1. E)  Supraventricular tachyarrhythmia

ANSWER: B

Advances in angiography, pharmacology, and systems of care have improved morbidity and mortality for acute myocardial infarction (AMI) over the last several decades. This has reduced the incidence of mechanical complications of AMI; however, the hospital mortality for these complications, such as acute papillary muscle rupture, remains high. Acute papillary muscle rupture occurs 3–5 days after a transmural infarction involving the right coronary artery or circumflex artery, depending on coronary anatomy. This leads to acute mitral regurgitation, resulting in flash pulmonary edema and shock, as seen in this patient.

Cardiac tamponade can occur after an AMI if the ventricular free wall ruptures, which is rare. Clinical clues include chest pain, shortness of breath, muffled heart sounds, and distended neck veins. Chest pain is also a core feature of pericarditis, making it an unlikely diagnosis in this patient. Pulmonary embolism (PE) is a common complication seen in immobile hospitalized patients and can be reduced with appropriate mechanical prophylaxis and chemoprophylaxis. While astute clinicians may rule out PE in this patient, her admission has likely included anticoagulation, and lack of edema makes a venous thromboembolism etiology for PE less likely. Arrhythmias can also occur after an AMI. Supraventricular tachyarrhythmias such as atrial fibrillation may present similarly to this patient, but a ventricular rate of 110 beats/min is unlikely to result in hemodynamic compromise as described in this case.
question stats:  our % right: 81 national % right: 78

pgy1: 8 pgy2: 7 pgy3: 7

so, why did i miss this? we really did not.

Multiple Choice

53. A 14-year-old male sees you to establish care. He has a past medical history of asthma and uses an albuterol inhaler (Proventil, Ventolin) as needed. He normally has symptoms about 3–4 days per week. Recent pulmonary function tests showed mildly reduced lung function.

    Based on the Global Initiative for Asthma (GINA) guidelines, which one of the following would be the preferred treatment strategy for this patient?

• 1. A)  Continuing as-needed albuterol

• 1. B)  Switching to as-needed formoterol

• 1. C)  Switching to an as-needed low-dose inhaled corticosteroid (ICS) plus formoterol

• 1. D)  Continuing as-needed albuterol, and adding a low-dose ICS for maintenance

• 1. E)  Continuing as-needed albuterol, and adding a low-dose ICS plus salmeterol for maintenance

ANSWER: C

Based on the Global Initiative for Asthma (GINA) guideline, patients who have symptoms <3–5 days per week with normal or mildly reduced lung function are classified as having mild asthma. For patients 12 years and older with mild asthma, the guidelines recommend treatment with as-needed low-dose inhaled corticosteroid plus formoterol (ICS/formoterol). As-needed low-dose ICS/formoterol reduces the risk of severe asthma exacerbations by 60%–64% compared to as-needed short-acting β-agonists (SABAs) such as albuterol. ICS/formoterol also reduces the risk of severe exacerbations compared to other regimens that include a SABA reliever. Formoterol should not be used without an ICS.
question stats: 

our % right: 15

national % right: 20

pgy1: 0

pgy2: 0

pgy3: 4

so, why did i miss this?
you read the question correctly....

Multiple Choice

53. A 37-year-old male who recently returned from a trip to Vietnam presents for evaluation of an intensely pruritic rash on his feet. Physical examination findings are normal other than an erythematous, serpiginous rash on his feet and lower legs.

    Which one of the following is the most likely diagnosis?

• 1. A)  Cutaneous larva migrans

• 1. B)  Cutaneous leishmaniasis

• 1. C)  Herpesvirus B

• 1. D)  Neisseria meningitidis

• 1. E)  Scabies

ANSWER: A

The most likely diagnosis is cutaneous larva migrans. The typical rash that occurs with this infection is an intensely pruritic, erythematous, serpiginous rash. It is typically seen on the feet and gluteal areas. There are no diagnostic tests for this infection and the diagnosis is made clinically. Infections are generally self-limited but can be treated with albendazole. Cutaneous larva migrans infections are mainly found in Asia and Africa where macaque monkeys are the reservoir. It has an incubation period of 1–5 days but can take up to 1 month.

Cutaneous leishmaniasis generally presents with small papules that develop into nonhealing open sores with a raised border and central ulceration. The lesions are generally painless. Herpesvirus B presents with a vesicular rash near the site of inoculation and influenza-like symptoms. The clinical manifestations of Neisseria meningitidis range from asymptomatic dermatologic findings such as petechiae to severe systemic disease. Scabies presents with a very pruritic rash that is red with small bumps, typically appears along skinfolds, and often forms a line.
question stats: 

our % right: 59

national % right: 66

pgy1: 6

pgy2: 6

pgy3: 4

so, why did i miss this?
don't see this much unless you goto africa and asia.