Rosh Review family med UPDATED ACTUAL Questions and CORRECT
Answers
1. A businessman, who Correct Answer ( C )
frequently travels in Explanation:
airplanes, complains
of painful ear pop- Barotitis media, barotrauma, or ear popping, are all names for eustachian
ping every time he tube dysfunction, a condition that occurs when the tube does not open
flies. He has tried properly during swallowing or yawning. This tube, connecting the middle
yawning, swallow- ear to the pharynx, equalizes pressure inside the ear to the atmospheric
ing, chewing gum pressure. Blockage of the tube can arise from congenital stenosis, abnormal
and pinching his peristaltic function, abnormal ciliary function, adenoid hypertrophy, nasal
nose, but nothing congestion and tumors. Risk factors include ear or sinus infections, allergies
seems to relieve the and rapid altitude changes. Symptoms include ear fullness, otalgia, tinnitus,
pain. He has even hearing impairment and vertigo. Diagnosis is mainly clinical, but further
tried using ibuprofen evaluation may involve an audiogram, tympanogam or otolaryngologist
two hours prior to referral. Treatment includes chewing gum, multiple swallows and exhalation
flight. through closed nostrils. If refractory, medications may be necessary, and
Which of the follow- include analgesics, oral antihistamines and nasal decongestants or steroids.
ing would you rec- Oxymetazoline is an over-the-counter nasal spray decongestant.
ommend?
A. Myringotomy
B.Nifedipine
C.Oxymetazoline
D.Ranitidine
2. A 26-year-old Correct Answer ( C )
woman presents for Explanation:
her annual exam and
is inquiring about Contraception counseling should be routinely performed in all women of
birth control. She is child-bearing age at every annual visit. There are many options such as
current on her im- behavioral, barrier and pharmacological methods. However, pharmacolog-
munizations and her ical therapy has the highest rate of pregnancy prevention and should be
,last pap smear was 2 recommended in all women, unless there are contraindications. This patient
, years ago. She is in has a history of migraines with aura which is considered a contraindication
a monogamous re- to estrogen use. Other contraindications to estrogen are history of deep
lationship with her vein thrombosis, breast cancer within the past 5 years, cigarette smoking
boyfriend and does in women more than 35 years of age who smoke more than 15 cigarettes
not have any im- per day, ischemic heart disease, stroke, active liver disease, major surgery
mediate plans for with prolonged immobilization and poorly controlled hypertension. In these
pregnancy. She has cases, progesterone only therapy (medroxyprogesterone) should be used
a history of mi- in the form of the intrauterine device, the injection or the subcutaneous
graines with aura but implantation in the arm.
does not require any
prescription medica-
tion.
Which of the fol-
lowing birth control
methods is the best
option for her?
A. Behavioral meth-
ods such as the with-
drawal method and
periodic abstinence
B. Etono-
gestrel/ethinyl estra-
diol vaginal
C. Medroxyproges-
terone acetate
D. Norelgestro-
min/ethinyl estradiol
transdermal
3. A 24-year-old Correct Answer ( D )
woman with no past Explanation:
, medical history pre-
sents with left wrist The patient presents with a markedly elevated blood pressure in the setting
pain after a fall. of pain from a trauma and should have pain control initiated and her blood
The left extremity pressure rechecked. Hypertension is defined as a persistent SBP >140 mm
is grossly deformed Hg or DBP >90 mm Hg. Pain and anxiety are common causes of elevated
and the patient com- blood pressure and heart rate in the outpatient setting. Historically, patients
plains of severe pain. with elevated blood pressure and nonspecific symptoms were referred to
The patient has a as hypertensive urgency but this term has fallen out of use. In a patient
blood pressure of presenting with elevated blood pressure who does not have signs or symp-
183/100 mm Hg. toms of end-organ damage, the clinician's focus should be on identifying
While awaiting external reasons for the elevated pressure and treating or addressing these.
X-rays, what man- In this case, the reduction or relief of pain will likely lead to decreased blood
agement is indicat- pressure.
ed for the patients
elevated blood pres- (A) Patients with elevated blood pressure and an absence of end-organ
sure? damage (e.g. acute coronary syndrome, aortic dissection, encephalopathy,
change in renal function) do not require admission for management. A pri-
A. Arrange admis- mary care physician in the outpatient setting best manages these patients.
sion for blood pres-
sure control (B) Starting a beta-blocker will not be beneficial in a patient with acute pain
B. Start an oral as the cause of elevated blood pressure.
beta-blocker and
(C) Similarly, administration of an intravenous beta-blocker and admission
monitor for re-
to the intensive care unit is not indicated as the patient exhibits no end-or-
sponse
gan damage.
C. Start intravenous
beta-blocker and ad-
mit to the intensive
care unit
D. Treat the patient's
pain and reassess
the blood pressure
Answers
1. A businessman, who Correct Answer ( C )
frequently travels in Explanation:
airplanes, complains
of painful ear pop- Barotitis media, barotrauma, or ear popping, are all names for eustachian
ping every time he tube dysfunction, a condition that occurs when the tube does not open
flies. He has tried properly during swallowing or yawning. This tube, connecting the middle
yawning, swallow- ear to the pharynx, equalizes pressure inside the ear to the atmospheric
ing, chewing gum pressure. Blockage of the tube can arise from congenital stenosis, abnormal
and pinching his peristaltic function, abnormal ciliary function, adenoid hypertrophy, nasal
nose, but nothing congestion and tumors. Risk factors include ear or sinus infections, allergies
seems to relieve the and rapid altitude changes. Symptoms include ear fullness, otalgia, tinnitus,
pain. He has even hearing impairment and vertigo. Diagnosis is mainly clinical, but further
tried using ibuprofen evaluation may involve an audiogram, tympanogam or otolaryngologist
two hours prior to referral. Treatment includes chewing gum, multiple swallows and exhalation
flight. through closed nostrils. If refractory, medications may be necessary, and
Which of the follow- include analgesics, oral antihistamines and nasal decongestants or steroids.
ing would you rec- Oxymetazoline is an over-the-counter nasal spray decongestant.
ommend?
A. Myringotomy
B.Nifedipine
C.Oxymetazoline
D.Ranitidine
2. A 26-year-old Correct Answer ( C )
woman presents for Explanation:
her annual exam and
is inquiring about Contraception counseling should be routinely performed in all women of
birth control. She is child-bearing age at every annual visit. There are many options such as
current on her im- behavioral, barrier and pharmacological methods. However, pharmacolog-
munizations and her ical therapy has the highest rate of pregnancy prevention and should be
,last pap smear was 2 recommended in all women, unless there are contraindications. This patient
, years ago. She is in has a history of migraines with aura which is considered a contraindication
a monogamous re- to estrogen use. Other contraindications to estrogen are history of deep
lationship with her vein thrombosis, breast cancer within the past 5 years, cigarette smoking
boyfriend and does in women more than 35 years of age who smoke more than 15 cigarettes
not have any im- per day, ischemic heart disease, stroke, active liver disease, major surgery
mediate plans for with prolonged immobilization and poorly controlled hypertension. In these
pregnancy. She has cases, progesterone only therapy (medroxyprogesterone) should be used
a history of mi- in the form of the intrauterine device, the injection or the subcutaneous
graines with aura but implantation in the arm.
does not require any
prescription medica-
tion.
Which of the fol-
lowing birth control
methods is the best
option for her?
A. Behavioral meth-
ods such as the with-
drawal method and
periodic abstinence
B. Etono-
gestrel/ethinyl estra-
diol vaginal
C. Medroxyproges-
terone acetate
D. Norelgestro-
min/ethinyl estradiol
transdermal
3. A 24-year-old Correct Answer ( D )
woman with no past Explanation:
, medical history pre-
sents with left wrist The patient presents with a markedly elevated blood pressure in the setting
pain after a fall. of pain from a trauma and should have pain control initiated and her blood
The left extremity pressure rechecked. Hypertension is defined as a persistent SBP >140 mm
is grossly deformed Hg or DBP >90 mm Hg. Pain and anxiety are common causes of elevated
and the patient com- blood pressure and heart rate in the outpatient setting. Historically, patients
plains of severe pain. with elevated blood pressure and nonspecific symptoms were referred to
The patient has a as hypertensive urgency but this term has fallen out of use. In a patient
blood pressure of presenting with elevated blood pressure who does not have signs or symp-
183/100 mm Hg. toms of end-organ damage, the clinician's focus should be on identifying
While awaiting external reasons for the elevated pressure and treating or addressing these.
X-rays, what man- In this case, the reduction or relief of pain will likely lead to decreased blood
agement is indicat- pressure.
ed for the patients
elevated blood pres- (A) Patients with elevated blood pressure and an absence of end-organ
sure? damage (e.g. acute coronary syndrome, aortic dissection, encephalopathy,
change in renal function) do not require admission for management. A pri-
A. Arrange admis- mary care physician in the outpatient setting best manages these patients.
sion for blood pres-
sure control (B) Starting a beta-blocker will not be beneficial in a patient with acute pain
B. Start an oral as the cause of elevated blood pressure.
beta-blocker and
(C) Similarly, administration of an intravenous beta-blocker and admission
monitor for re-
to the intensive care unit is not indicated as the patient exhibits no end-or-
sponse
gan damage.
C. Start intravenous
beta-blocker and ad-
mit to the intensive
care unit
D. Treat the patient's
pain and reassess
the blood pressure
