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Family Medicine (AAFP Questions) Solved -Graded A+ 2024
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Family Medicine (AAFP Questions) Solved -Graded A+ 2024
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Family Medicine (AAFP Questions)Solved -Graded A+ 2024
MCC of HTN in children < 6 yrs - ANSWER-renal parenchymal dz (urinalysis, urine culture, and renal ultrasonography should be ordered for all children presenting with hypertension)
TZDs should not be used in patients - ANSWER-with New York Heart Association class III or IV heart failure
next step in management if patient is already on maximum therapy for CHF? - ANSWER-cardiac resynchronization therapy (look for bundle branch block and EF less than or equal to 30%)
what dietary recommendation has been shown to decrease the rate of a sudden death due to cardiovascular disease? - ANSWER-Increased intake of omega-3 fax
chest radiograph shows widening of the mediastinum, enlargement of the aortic knob, or tracheal displacement -> Dx?
Management? - ANSWER-dissecting aortic aneurysm
Acute dissection of the ascending aorta is a surgical emergency, but dissections confined to the descending aorta are managed medically unless the patient demonstrates progression or continued hemorrhage into the retroperitoneal space or pleura.
initial medical management aortic dissections confined to the descending aorta? - ANSWER-reduce the systolic blood pressure to 100-120 mmHg or to the lowest level tolerated (use beta blockers such as propranolol or labetalol to get the heart rate below 60 beats per minute, if systolic blood pressure remains over 100 mmHg, IV nitroprusside should be added... but must have beta-blockade before her nitroprusside because of vasodilation from nitroprusside will induce reflex activation of the sympathetic nervous system,, causing increased ventricular contraction and increased shear stress on the aorta)
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can usually be terminated by the administration of intravenous ___ - ANSWER-verapamil or a β-blocker. If that fails, intravenous propafenone or flecainide may be necessary. electrical cardioversion may be necessary if these measures fail to terminate the tachycardia arrhythmia (also remember to treat contributing causes such as hypovolemia, hypoxia, or electrolyte disturbances). monotherapy for hypertension and African American patients is more likely to consist of ___ - ANSWER-diuretics for calcium channel blockers (rather than 8 a blockers or ACE inhibitors; it has been suggested that hypertension and African American does not as angiotensin II dependent as it appears to be in Caucasians)
carvedilol and metoprolol are metabolized by the __ - ANSWER-liver
enoxaparin isn't metabolized by the ___ - ANSWER-kidneys ( requires dosage adjustment in renal disease)
inpatient with MI, new left bundle branch block suggests ___
What is indicated in this situation? - ANSWER-Occlusion of LAD, placing a significant portion of LV in jeopardy
Thrombolytic therapy (this would be harmful in a patient with ischemia but no infarction-
they will show ST segment depression only)
isolated systolic hypertension in the elderly responds best to ___ - ANSWER-diuretics (and beta blockers to a lesser extent)
thiazide diuretics can improve osteoporosis
31 yo F pt found to have thrombus in axillosubclavian vein (only activity she recalls is digging strenuously to plant a garden the prior day) -> what is Dx? - ANSWER-a compressive anomaly in the thoracic outlet (these are usually bilateral so there is similar
risk on the other side)
For patients with a first episode of unprovoked deep venous thrombosis, evidence supports treatment with ___ - ANSWER-warfarin for at least 3 months
profuse perspiration with feeding and a 6 month old suggests? - ANSWER-CHF
you diagnose a patient with aortic stenosis view only complains of dyspnea on exertion (denies chest pain and syncope), echo shows transvalvular gradient of 55 mmHg and a calculated valve area of 0.6 cm^2 -> Management? - ANSWER-Valve replacement (patients with symptomatic aortic stenosis had dismal prognosis without treatment, prompt correction of mechanical obstruction with aortic valve replacement is indicated)
Contraindications to beta-blocker use include...? - ANSWER-hemodynamic instability, heart block, bradycardia, and severe asthma. Beta-blockers may be tried in patients with mild asthma or COPD as long as they are monitored for potential exacerbations. how are patients who are capable of moderate activity (greater than 4 METs) without cardiac symptoms cleared for surgery? - ANSWER-A resting 12-lead EKG is recommended for males over 45, females over 55, and patients with diabetes, symptoms of chest pain, or a previous history of cardiac disease. No stress testing or coronary angiography for elective minor or intermediate-risk operations (even if pt had prior cardiac hx but is now asymptomatic).
a patient in her third trimester has 2+ pitting edema bilaterally, blood pressure is 118/78 -> management of edema? - ANSWER-leg swelling requires no further evaluation
what can be used for cardiac prophylaxis both before and after her surgery in patients with known cardiac disease or cardiac risk factors? - ANSWER-Beta blockers
best initial approach for atrial fibrillation - ANSWER-ventricular RATE control with calcium channel blocker or beta blocker (digoxin is less effective for rate control and should be reserved as an add-on for patients not controlled with the beta blocker or calcium channel blocker, or for patients with significant LV systolic dysfunction) and anti-coagulation with warfarin
cilostazol (useful for treatment of intermittent claudication) should be avoided in patient's
with? - ANSWER-CHF
patients with long QT syndrome that had sudden arrhythmia death syndrome usually have? - ANSWER-torsades de pointes or V. fib
Clinical predictors of increased perioperative cardiovascular risk for elderly patients include major risk factors such as - ANSWER-unstable coronary syndrome (acute or recent myocardial infarction, unstable angina), decompensated congestive heart failure,
significant arrhythmia (high-grade AV block, symptomatic ventricular arrhythmia, supraventricular arrhythmias with uncontrolled ventricular rate), and severe valvular disease.
Intermediate clinical predictors of increased perioperative cardiovascular risk for elderly patients include - ANSWER-mild angina, previous myocardial infarction, compensated congestive heart failure, diabetes mellitus, and renal insufficiency.
Minor clinical predictors of increased perioperative cardiovascular risk for elderly patients include - ANSWER-advanced age, an abnormal EKG, left ventricular hypertrophy, left bundle-branch block, ST and T-wave abnormalities, rhythm other than sinus, low functional capacity, history of stroke, and uncontrolled hypertension.
Subclinical hypothyroidism (TSH >10 µU/mL) is likely to progress to overt hypothyroidism, and is associated with increased ___ - ANSWER-LDL cholesterol.
Subclinical hyperthyroidism (TSH <0.1 µU/mL) is associated with the development of ___ - ANSWER-atrial fibrillation, decreased bone density, and cardiac dysfunction. ___ therapy can elevate calcium levels by elevating parathyroid hormone secretion from
the parathyroid gland. This duplicates the laboratory findings seen with mild primary hyperparathyroidism. - ANSWER-Lithium
A patient with a recurrent kidney stone and an elevated serum calcium level most likely has ___ - ANSWER-hyperparathyroidism (Elevated PTH is caused by a single parathyroid adenoma in approximately 80% of cases.)
When evaluating a patient with a solitary thyroid nodule, red flags indicating possible thyroid cancer include - ANSWER-male gender; age <20 years or >65 years; rapid growth of the nodule; symptoms of local invasion such as dysphagia, neck pain, and hoarseness; a history of head or neck radiation; a family history of thyroid cancer; a hard, fixed nodule >4 cm; and cervical lymphadenopathy.
___, even if well controlled, disqualifies a driver for commercial interstate driving - ANSWER-Insulin-dependent diabetes
___ may present in one of three ways: as a sudden onset of bilious vomiting and abdominal pain in a neonate; as a history of feeding problems with bilious vomiting that appears to be a bowel obstruction; or less commonly, as failure to thrive with severe feeding intolerance. - ANSWER-Volvulus
The classic finding on abdominal plain films for volvulus is ___ - ANSWER-the double bubble sign, which shows a paucity of gas (airless abdomen) with two air bubbles, one in the stomach and one in the duodenum.
___ is the most common congenital abnormality of the small intestine. It is prone to bleeding because it may contain heterotopic gastric mucosa. Abdominal pain, distention, and vomiting may develop if obstruction has occurred, and the presentation may mimic appendicitis. - ANSWER-Meckels diverticulum
Eradication of ___ significantly reduces the risk of ulcer recurrence and rebleeding in patients with duodenal ulcer, and reduces the risk of peptic ulcer development in patients on chronic NSAID therapy. - ANSWER-Helicobacter pylori (Eradication has minimal or no effect on the symptoms of nonulcer dyspepsia and gastroesophageal reflux disease)
Although H. pylori infection is associated with gastric cancer, have trials shown that eradication of H. pylori purely to prevent gastric cancer is beneficial? - ANSWER-No
What organisms are resistant to chlorine and are important causes of gastroenteritis from drinking water? - ANSWER-Cryptosporidium oocysts, Giardia cysts, Entamoeba histolytica and hepatitis A virus
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