Family Med Questions Flashcards
54 y/o woman with DM. She has been very difficult to control. You are monitoring urine microalbumin level and want to be alert to other changes that would suggest chronic renal insufficiency. If the pt were to develop chronic renal failure, which lab abnormality would you most likely see first?
A. Hyperkalemia B. Hyponatremia C. Hyperphosphatemia D. Fall in plasma bicarb level E. Anemia
E. Anemia
[this starts around GFR of 55]
53 y/o male presents with pancreatitis. Labs show WBC 18,000, glucose of 153, LDH of 254, and AST of 165. According to Ranson criteria, which of these factors suggests poor prognosis?
A. Age B. WBC count C. Glucose D. LDH E. AST
B. WBC count
5 Ranson criteria — poor prognosis if age >55, WBC > 16,000, glucose >200, LDH > 350, and AST > 250
65 y/o woman with hx of diabetes and HTN. She is overweight and does not exercise regularly. You are concerned that she may have renal failure based on risk factors. Which is the best test to detect renal insufficiency in this pt?
A. BUN level B. Serum creatinine C. BUN:Cr ratio D. Calculated or estimated GFR E. Urine microalbumin level
D. Calculated or estimated GFR
Which of the following medication options has been proven to lower BP and prevent recurrent stroke?
A. ACE inhibitor B. HCTZ C. ACE inhibitor + HCTZ D. Beta blocker E. Beta blocker + HCTZ
C. ACE inhibitor + HCTZ
45 y/o female with significant jaundice. Alk phos is 7x normal, and transaminases are 2x normal. US of RUQ is negative for obstruction and shows no bile duct dilation. You still suspect obstruction. What is the next step in workup?
A. CT abdomen B. ERCP C. Percutaneous transhepatic cholangiography D. MRCP E. HIDA scan
D. MRCP
46 y/o man presents with 3 months of upper abdominal discomfort associated with heartburn, frequent belching, bloating, and occasional nausea. What is the most likely result that will be found after workup for these sxs?
A. PUD B. GERD C. Gastric cancer D. Gastroparesis E. No cause is likely to be identified
E. No cause is likely to be identified
No specific etiology is found in 50-60% of pts with dyspepsia
Which of the following is recommended tx for pertussis?
A. 10 days of amoxicillin B. 10 days of amoxicillin-clavulanate C. 7 days of erythromycin D. 5 days of azithromycin E. Isolation and supportive care
D. 5 days of azithromycin
[options are either 14 days of erythromycin or 5 days of azithromycin]
18 y/o female presents with asthma. She smokes and reports needing to use her SABA daily. She gets flares at least 2x per week and while some days are relatively symptom free, some exacerbations may last several days. She wakes up at least once per week with symptoms. Which of the following is her classification?
A. Mild intermittent B. Moderate intermittent C. Mild persistent D. Moderate persistent E. Severe persistent
D. Moderate persistent
If a pt with dyslipidemia quits smoking and remains a nonsmoker, how would you expect his lipid profile to change?
A. Total cholesterol will decrease B. LDL will decrease C. Fasting triglycerides will decrease D. HDL will increase E. VLDL will decrease
D. HDL will increase
Which of the following lab values is likely to decrease in the fasting state?
A. Serum triglycerides B. HDL C. LDL D. Total cholesterol E. VLDL
A. Serum triglycerides
Which of the following is true of treatment for oral herpes?
A. Oral antivirals are less effective in treating primary infections than treating recurrences
B. Oral therapy begun within 2 days of onset is best for recurrent outbreaks
C. Chronic suppression with daily therapy is beneficial for oral herpes
D. Acyclovir resistance makes it a poor choice
E. Famciclovir is less effective than valacyclovir
C. Chronic suppression with daily therapy is beneficial for oral herpes
34 y/o woman reports amenorrhea for 4 months. She has never been “regular” but has never gone this long without a period. Labs are normal including a negative pregnancy test. You give her medroxyprogesterone acetate for 7 days and the next week she has a period. Which of the following is the most likely cause of her amenorrhea?
A. Premature ovarian failure B. Ovarian neoplasm C. Turner syndrome D. Asherman syndrome E. Polycystic ovarian syndrome
E. Polycystic ovarian syndrome
44 y/o African American with T2DM is on a maximum dose of sulfonylurea, but her A1c is 9.2%. Baseline labs show normal liver enzymes and creatinine of 2.3. Which of the following would be most beneficial?
A. Change to another sulfonylurea B. Add a biguanide C. Add a meglitinide D. Add a thiazolidinedione E. Add an alpha glucosidase inhibitor
D. Add a thiazolidinedione
Thiazolidinediones decrease insulin resistance and are an excellent choice for those with insulin insensitivity.
No evidence supports changing sulfonylureas. Biguanides should not be used if creatinine is higher than 1.5. Meglitinides increase insulin secretion and should only be taken before meals - they can reduce A1c by 0.5-2% and are most valuable if fasting sugar is adequate but postprandial sugars are high. Since they increase insulin levels, they should be used with another med with a different MOA. They are excreted by the liver and thus are safe in renal failure. Alpha glucosidase inhibitors inhibit the absorption of carbs in the gut and can decrease A1c by 0.7-1%. They should be avoided if creatinine is >2.
6 y/o presents with bedwetting. She was toilet trained at age 3. Four months ago, her parents had another child and the 6 year old began to wet the bed again. She has no other medical conditions. Which of the following terms describes this condition?
A. Childhood incontinence B. Primary monosymptomatic enuresis C. Secondary monosymptomatic enuresis D. Non-monosymptomatic enuresis E. Primary intentional enuresis
C. Secondary monosymptomatic enuresis
Primary monosymptomatic enuresis = bedwetting without hx of nocturnal continence
Secondary monosymptomatic enuresis = recurrence of bedwetting after at least 6 months of nocturnal continence
Non-monosymptomatic enuresis = bedwetting associated with urgency, frequency, pain, constipation, encopresis, etc
42 y/o female presents with dizziness that began several months ago at which time she reported subjective hearing loss and ringing in the left ear only. Symptoms were mild, and her PE was normal, so you elected to follow her. Since then, she has noticed dizziness and some facial numbness. Most likely dx?
A. Vestibular neuronitis B. BPPV C. Acoustic neuroma D. Meniere disease E. Cerebellar tumor
C. Acoustic neuroma
68 y/o man presents with fatigue. Hx of HTN that is well controlled with HCTZ. He recently lost 30 lbs on low carb/high protein diet and drinks 2-3 beers daily. He smokes 10 cigs daily. Labs reveal macrocytic anemia with B12 deficiency. Which is the most likely cause?
A. HCTZ side effect B. High protein diet C. Low carb diet D. Alcohol intake E. Inadequate B12 absorption
E. Inadequate B12 absorption
62 y/o female complains of dyspnea. She has a hx of COPD, HTN, and DM. She also smokes and drinks heavily. Evaluation reveals she is in heart failure. Which of the following will lead to functional improvement in this pt?
A. Optimize tx of COPD B. Optimize tx of HTN C. Optimize glycemic control D. Discontinue smoking E. Discontinue alcohol
E. Discontinue alcohol
Pt with long-standing HIV infection has been off meds for several months and presents with PCP pneumonia. He complains of shortness of breath and blood gases reveal a PaO2 of 60 mmHg. Assuming pt is not allergic, which of the following is first-line tx?
A. Azithromycin B. TMP-SMX C. TMP-SMX + corticosteroids D. Triple-drug tx against TB E. Quadruple drug tx against TB
C. TMP-SMX + corticosteroids
Add steroids when O2 sat <90 or PaO2 <65
66 y/o female with heart failure. She has hx of HTN but heart failure dx is new. Which of the following is done routinely in initial eval of new onset heart failure?
A. Echocardiogram B. Holter monitor C. Left heart cath D. Treadmill stress test E. Pharm stress test
A. Echocardiogram
Echo is useful to get EF. New dx of heart failure also gets ECG, CBC, UA, serum creatinine, potassium, albumin, and TSH.
39 y/o otherwise healthy male with family history of ischemic heart disease is complaining of chest pressure that radiates to the jaw when he walks up stairs at work. You order an ECG in the office that shows a left bundle branch block. Which of the following is the test of choice to determine if his chest pain is due to cardiac ischemia?
A. Exercise treadmill test B. Thallium exercise treadmill test C. Stress echo D. Persantine/thallium test E. Dobutamine echocardiogram
B. Thallium exercise treadmill test
The standard test for ischemic heart disease is an exercise treadmill test, but certain ECG results make it unreadable including LVH with strain, LBBB, and ST segment baseline abnormalities in precordial leads. In these cases, thallium ETT is preferred as long as pt can exercise
21 y/o college student presents after syncopal episode while playing basketball. This has never happened before. He has no significant PMH. On exam, you note harsh crescendo-decrescendo systolic murmur, heard best at the apex and radiating to the axilla. Which of the following tests is most likely to reveal the etiology of his syncopal episode?
A. Echocardiogram B. Holter monitoring C. ECG D. Stress test E. Tilt table test
A. Echocardiogram
[in syncopal pts that have a heart murmur, best test is echo. This will also show hypertrophic cardiomyopathy, which is most likely dx here]
Pt presents with painful swollen knee. Joint aspirate reveals clear fluid with a WBC count of 5000, 20% of which are PMN leukocytes. Which of the following is the most likely dx?
A. Gout B. Pseudogout C. Infectious arthritis D. Osteoarthritis E. Rheumatoid arthritis
D. Osteoarthritis
Which of the following meds has been shown to delay functional impairment and disease progression in Parkinsons?
A. Selegiline B. Carbidopa-levodopa C. Bromocriptine D. Pramipexole E. Ropirinole
A. Selegiline
The others are symptomatic relief only
Most common cause of acute sinusitis
A. Moraxella catarrhalis B. Staph aureus C. Group A beta-hemolytic strep D. Strep pneumo E. Polymicrobial
D. Strep pneumo
36 y/o man presents with elevated BP of 163/90, and on a f/u visit his BP is 158/102. Despite conservative measures, his next visit BP is 166/92. Which of the following is the next best step in management?
A. Start thiazide B. Start ACE inhibitor C. Start ARB D. Start beta blocker E. Start 2-drug regimen
E. Start 2-drug regimen
[stage II HTN requires 2 drug therapy]
33 y/o female present with chronic pelvic pain and you suspect endometriosis. Which of the following tests would be most helpful in determining the cause of her pain?
A. CBC B. ESR C. CA-125 D. Transvaginal US E. MRI
E. MRI
