Tabitha ITE 1

An otherwise healthy 29-year-old gravida 2 para 1 at 28 weeks gestation presents to your office with a laceration sustained while doing yard work. After thoroughly cleaning the wound, you decide not to suture it because of the risk of infection. The patient received Tdap during her previous pregnancy 6 years ago and you confirm in her medical records that she completed her primary immunizations as a child. Which one of the following would be most appropriate regarding tetanus prophylaxis?

• No tetanus prophylaxis

• Tetanus immune globulin now

• Tdap now

• Td now

A 12-year-old female presents with a sore throat and tonsillar exudate, and a rapid antigen test is positive for streptococcal pharyngitis. She returns to your office after completing a 10-day course of penicillin this morning. She says that although she saw some initial improvement, she now has a sore throat again, accompanied by a runny nose and cough. Her mother asks if another antibiotic would be appropriate. A physical examination reveals nonexudative pharyngitis, but a rapid antigen test for group A Streptococcus is again positive. Which one of the following would be the most appropriate treatment at this point?

• no further antibiotics

• oral azithromycin for 5 days

• oral cipro for 10 days

• a single dose of IM penicillin

• a single dose of IM ceftriaxone

The American Academy of Pediatrics recommends obtaining a blood pressure reading at well child checks beginning at what age?

• 18 months

• 2 years

• 3 years

• 4 years

• 5 years

A 37-year-old female presents to your clinic with a long-standing history of abnormal menstrual cycles, often occurring irregularly more than 40 days apart. She has ongoing struggles with weight gain, acne, and facial hair growth. She states that she is not currently sexually active. Her last Papanicolaou smear 2 years ago was normal. Her vital signs and a physical examination are unremarkable other than a BMI of 36 kg/m2 . An office urine pregnancy test is negative. Laboratory evaluation reveals a hemoglobin A1c of 6.2%, and normal TSH, prolactin, and 17-hydroxyprogesterone levels. Which one of the following is required to confirm the most likely diagnosis?

• No additional evaluation

• A serum c-peptide

• A dexamethasone suppression test

• ultrasonography of pelvis

• CT scan of the pelvis

A 35-year-old female at 36 weeks gestation presents to your office. She reports that for the past few days she has had itching of her palms and soles that has been quite bothersome. She has tried moisturizer with no improvement. A physical examination is unremarkable with no rashes, erythema, or warmth of the palm and soles. The patient otherwise feels well.

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

• Low potency steroid cream

• tacrolimus topical

• certirizine

• Bile acid levels

• BUN/Creatinine ratio

A 4-year-old female is brought to your office by her father for a well child check. The father reports that the child is having difficulty using her albuterol (Proventil, Ventolin) metered-dose inhaler for asthma exacerbations and he is not sure whether it is improving her symptoms. On demonstration in the office, the child is unable to time her breathing with inhaler actuation.

Which one of the following would you recommend?

• montelukast

• albuterol via oral liquid

• albuterol MDI with a spacer

• albuterol via nebulizer

• salmeterol inhaler

A 15-year-old female presents for a well adolescent examination and reports painful, heavy periods. Menarche occurred at age 11, and by age 12 her menses were regular but quite painful. She misses at least 1 day of school each month due to the discomfort. She has tried acetaminophen/caffeine/pyrilamine (Midol Complete) and ibuprofen, 200 mg, without much relief. She is not sexually active. Her past medical history and surgical history are unremarkable. A urine pregnancy test is negative.

Which one of the following would be the most appropriate next step for this patient?

• empiric treatment with max dose naproxen

• screening for STDs

• a pelvic exam

• pelvic ultrasound

• referral to gynecologist

A 34-year-old gravida 2 para 2 presents for a postpartum examination 6 weeks after an uncomplicated vaginal delivery. Both the mother and infant are doing well. Her only complication during the pregnancy was an abnormal 3-hour glucose tolerance test. She managed her blood glucose with a combination of diet and exercise and delivered at 39 weeks gestation. The patient’s vital signs and a physical examination are normal today.

Which one of the following should you recommend for this patient based on her history of gestational diabetes?

• No glucose testing today, and initiation of metformin to prevent diabetes

• No glucose testing today, and annual screening with a fasting plasma glucose level starting 1 year after delivery

• No further glucose testing unless she becomes pregnant again

• A 2-hour plasma glucose level using a 75-g oral glucose load

Which one of the following disorders is caused by an underlying mechanism of osteochondrosis rather than apophysitis?

• Legg-Calvé-Perthes disease

• Osgood-Schlatter disease

• Sever’s disease

• Sinding-Larsen-Johansson syndrome

Which one of the following vaccines is CONTRAINDICATED during pregnancy?

• Hepatitis A

• Hepatitis B

• Rabies

• Tdap

• Varicella