Family Medicine Shelf || Full Exam Pack: A+ Verified
Questions & Answers!!
Two Type 2 diabetic treatments allowed in children? correct answers 1. Insulin
2. Metformin
- What beta blocker is best in CHF treatment?
- What are max doses of Lasix / ACE-I?
- If patient is symptomatic on max doses of all meds, next step? correct answers - Carveidolol
(Comet Trial)
- Lasix = 80 mg
- ACE-I = 40 mg
- Biventricular Pacing
3 Beta Blockers for CHF Patients correct answers Metoprolol (b1 specific)
Bisoprolol (b1 specific)
Carveidolol (nonspecific with alpha antagonist properties)
Omega 3 Fatty Acids
- Mechanism of Protection
- Long Term Benefits (3)
- Use in high risk patients, esp allergic to ____ correct answers - Mechanism: increase
eicosonoid production = decrease platelets/increase vasodilation
- 3 Longterm Benefits: decrease stroke, non-fatal MI and arrhythmias
- Good for people allergic to fish
Management for Descending Aortic Dissection:
- Rx (2)
- When to Operate? correct answers Rx:
1. Beta Blocker IV
2. Nitroprusside: always give BB first b/c this will cause reflex SNS activity which will
increase LV output and shear stress on aorta
Operate:
- If ascending component
- If major branches are involved
Recommendations for AAA Screening correct answers All males between 65-75 who have
ever smoked. One time screening is recommended unless pathology is found.
LDL Goal for Diabetics correct answers <100
Benign Childhood Murmurs (3)
What components of murmur will NEVER include it in benign murmurs of childhood (3).
correct answers 1. Still's Murmur: S = S, still's best heard when supine; musical
2. Peripheral Pulmonic Stenosis: systolic murmur radiating to b/l axilla
3. Venous Hum: 2/2 fluttering open/close of jugular veins; best heard when UPRIGHT (vs.
Still's) and on INSPIRATION (b/c venous)
,NON-BENIGN FEATURES
1. Diastolic
2. Extra sound
3. >2/6 on Levine Scale
Management of Stable Angina (2) correct answers 1. Beta Blocker
2. ASA
Indications for thrombolytic therapy in AMI? (2) correct answers Both are on EKG
1. Ensure STEMI
- ≥1mm elevation in 2x limb leads
- ≥2 mm elevation in 2x precordial leads
2. Look for New onset LBBB which is c/w complete occlusion
You suspect secondary HTN in a patient. Knowing one of the MCC, what is the best test to
order? correct answers AM Aldosterone/Renin Ratio looking for primary
hyperaldosteronism. If ratio >20 = Dx!
Note: Renovascular HTN (with RAS is MCC 2/2 HTN)
Foot Pain:
1. Plantar Fasciitis (Etiology, Presentation, Treatment)
2. Tarsal Tunnel (Etiology, Presentation)
3. Fat Pad Atrophy (Etiology, Presentation) correct answers 1. Plantar Fasciitis
- Etiology: 2/2 overuse (repetitive micro trauma) = obese/always on feet
- Presentation: heel pain with "First step phenomenon", gets better throughout day
- Treatment: OTC Heel Inserts / Achilles Tendon Stretching / NSAID --> Steroid Shot -->
Surgery
2. Tarsal Tunnel
- Etiology: compression of post tibial nerve deep to med malleoulus
- Presentation: medial foot / plantar paresthesias with pain on tapping tarsal tunnel
3. Fat Pad Atrophy
- Etiology: atrophy of fat pad over heel
- Presentation: pain worsens throughout the day
Best anticoagulation for patient undergoing hip repair who has history of previous post-op
DVT? correct answers SubQ Lovenox before and after surgery
Recommendations for Patients with HCM (2)
(T/F) HCM Patients have decrease lifespan correct answers Recs:
1. No strenuous activity
2. Screen all first degree with ECHO
False. Risk of SCD 1-5%
3 CIs to using Beta Blockers in CHF? correct answers 1. Bradycardia
,2. Heart Block
3. Severe Asthma
Pre-Op Cardiac Risk
- Protocol
- Classify procedures into High / Int / Low Risk correct answers - Protocol: 12 Lead -->
Stress Test if + --> Cath if +
- Classification
1. HIGH RISK: anything vascular / emergency
2. INT RISK: head/neck, thoracic/abdominal, prostate
3. LOW RISK: Breast, Cataract, Endoscopic
Marelgia Paresthetica correct answers Compression of LFCN --> sensory loss of ant/lat thigh
without motor deficits
Pt with fatigue, adenopathy and pharyngitis is giving ampicillin / PCN. They develop a
morbilliform rash. If this patient is then admitted to the ED with respiratory distress, what is
the next best step? correct answers Add steroids. Patient has MONO; airway obstruction 2/2
inflammation. Give steroids.
5 Malignancies associated with EBV? correct answers 1. Nasopharyngeal Carcinoma
2. Primary CNS Lymphoma
3. Burkitt's
4. Hodgkins
5. (HIV) Hairy Leukoplakia
HyperCa of Malignancy
- 3 Etiologies
- Management Protocol correct answers - 3 Etiologies: PTHrP >>> Mets with Release of
Local Factors >>> Ectopic PTH Secretion
- Management:
1. IVF
2. +/- Lasix to avoid IVF overload
3. Calcitonin (Acute management) vs. Bisophosphonate (chronic management)
Treatment of Torsades? correct answers Mg
10 y/o has older sibling who died suddenly in a soccer game. His parents have had recurrent
syncopal episodes.
- What do you suspect?
- Next best diagnostic step?
- Management? correct answers - Suspect Long QT Syndrome
- Diagnostic Step: RESTING (≠Stress EKG) for long QT interval
- Management: beta blockers and NO competitive sports
WPW
- EKG Findings (3)
- Treatment correct answers EKG Findings in WPW
, - Short PR Interval
- Narrow QRS
- Delta wave
Treatment: Procainamide
You are considering starting a RA / AI patient on TNF-alpha blocker. What 3 diseases do you
screen for? correct answers 1. Hep B
2. Hep C
3. TB
Lab Test to W/U Suspected HCV (3 Components) correct answers 1. ELISA for HCV
Antibody
+: Proceed to 2nd Immuno Based Assay (#2 below)
-: Not infected or very early infection
2. Immunobased Assay for HCV Antibody
+: Proceed to test for active / resolved infection (#3 below)
-: Original ELISA was a false+
3. HCV RNA PCR
+: Active Disease
-: Resolved disease
OCD:
- First Line Treatment (2)
- Alternative to First Line Rx Treatment correct answers - First Line Treatment
1. SSRI
2. Exposure-Response Therapy
- Alternative
1. Clomipramine
NHAP
- Why to think about different bugs?
- Inpatient vs. Outpatient Management correct answers NHAP: increase colonization of
oropharynx with GNR
Management
1. Inpatient: Cover MRSA (Vanc/Linezolid) and 2x Anti-Psuedomonal (Resp
Fluoroquinolone and Cephalosporin)
2. Outpatient: Resp Fluoroquinolone
1. Standard Management of Osteoporosis (3 components)
2. Rx that Decrease Hip Fractures (3)
3. Rx for Post-menopausal women with Osteoporosis and FMH of Breast Cancer
Questions & Answers!!
Two Type 2 diabetic treatments allowed in children? correct answers 1. Insulin
2. Metformin
- What beta blocker is best in CHF treatment?
- What are max doses of Lasix / ACE-I?
- If patient is symptomatic on max doses of all meds, next step? correct answers - Carveidolol
(Comet Trial)
- Lasix = 80 mg
- ACE-I = 40 mg
- Biventricular Pacing
3 Beta Blockers for CHF Patients correct answers Metoprolol (b1 specific)
Bisoprolol (b1 specific)
Carveidolol (nonspecific with alpha antagonist properties)
Omega 3 Fatty Acids
- Mechanism of Protection
- Long Term Benefits (3)
- Use in high risk patients, esp allergic to ____ correct answers - Mechanism: increase
eicosonoid production = decrease platelets/increase vasodilation
- 3 Longterm Benefits: decrease stroke, non-fatal MI and arrhythmias
- Good for people allergic to fish
Management for Descending Aortic Dissection:
- Rx (2)
- When to Operate? correct answers Rx:
1. Beta Blocker IV
2. Nitroprusside: always give BB first b/c this will cause reflex SNS activity which will
increase LV output and shear stress on aorta
Operate:
- If ascending component
- If major branches are involved
Recommendations for AAA Screening correct answers All males between 65-75 who have
ever smoked. One time screening is recommended unless pathology is found.
LDL Goal for Diabetics correct answers <100
Benign Childhood Murmurs (3)
What components of murmur will NEVER include it in benign murmurs of childhood (3).
correct answers 1. Still's Murmur: S = S, still's best heard when supine; musical
2. Peripheral Pulmonic Stenosis: systolic murmur radiating to b/l axilla
3. Venous Hum: 2/2 fluttering open/close of jugular veins; best heard when UPRIGHT (vs.
Still's) and on INSPIRATION (b/c venous)
,NON-BENIGN FEATURES
1. Diastolic
2. Extra sound
3. >2/6 on Levine Scale
Management of Stable Angina (2) correct answers 1. Beta Blocker
2. ASA
Indications for thrombolytic therapy in AMI? (2) correct answers Both are on EKG
1. Ensure STEMI
- ≥1mm elevation in 2x limb leads
- ≥2 mm elevation in 2x precordial leads
2. Look for New onset LBBB which is c/w complete occlusion
You suspect secondary HTN in a patient. Knowing one of the MCC, what is the best test to
order? correct answers AM Aldosterone/Renin Ratio looking for primary
hyperaldosteronism. If ratio >20 = Dx!
Note: Renovascular HTN (with RAS is MCC 2/2 HTN)
Foot Pain:
1. Plantar Fasciitis (Etiology, Presentation, Treatment)
2. Tarsal Tunnel (Etiology, Presentation)
3. Fat Pad Atrophy (Etiology, Presentation) correct answers 1. Plantar Fasciitis
- Etiology: 2/2 overuse (repetitive micro trauma) = obese/always on feet
- Presentation: heel pain with "First step phenomenon", gets better throughout day
- Treatment: OTC Heel Inserts / Achilles Tendon Stretching / NSAID --> Steroid Shot -->
Surgery
2. Tarsal Tunnel
- Etiology: compression of post tibial nerve deep to med malleoulus
- Presentation: medial foot / plantar paresthesias with pain on tapping tarsal tunnel
3. Fat Pad Atrophy
- Etiology: atrophy of fat pad over heel
- Presentation: pain worsens throughout the day
Best anticoagulation for patient undergoing hip repair who has history of previous post-op
DVT? correct answers SubQ Lovenox before and after surgery
Recommendations for Patients with HCM (2)
(T/F) HCM Patients have decrease lifespan correct answers Recs:
1. No strenuous activity
2. Screen all first degree with ECHO
False. Risk of SCD 1-5%
3 CIs to using Beta Blockers in CHF? correct answers 1. Bradycardia
,2. Heart Block
3. Severe Asthma
Pre-Op Cardiac Risk
- Protocol
- Classify procedures into High / Int / Low Risk correct answers - Protocol: 12 Lead -->
Stress Test if + --> Cath if +
- Classification
1. HIGH RISK: anything vascular / emergency
2. INT RISK: head/neck, thoracic/abdominal, prostate
3. LOW RISK: Breast, Cataract, Endoscopic
Marelgia Paresthetica correct answers Compression of LFCN --> sensory loss of ant/lat thigh
without motor deficits
Pt with fatigue, adenopathy and pharyngitis is giving ampicillin / PCN. They develop a
morbilliform rash. If this patient is then admitted to the ED with respiratory distress, what is
the next best step? correct answers Add steroids. Patient has MONO; airway obstruction 2/2
inflammation. Give steroids.
5 Malignancies associated with EBV? correct answers 1. Nasopharyngeal Carcinoma
2. Primary CNS Lymphoma
3. Burkitt's
4. Hodgkins
5. (HIV) Hairy Leukoplakia
HyperCa of Malignancy
- 3 Etiologies
- Management Protocol correct answers - 3 Etiologies: PTHrP >>> Mets with Release of
Local Factors >>> Ectopic PTH Secretion
- Management:
1. IVF
2. +/- Lasix to avoid IVF overload
3. Calcitonin (Acute management) vs. Bisophosphonate (chronic management)
Treatment of Torsades? correct answers Mg
10 y/o has older sibling who died suddenly in a soccer game. His parents have had recurrent
syncopal episodes.
- What do you suspect?
- Next best diagnostic step?
- Management? correct answers - Suspect Long QT Syndrome
- Diagnostic Step: RESTING (≠Stress EKG) for long QT interval
- Management: beta blockers and NO competitive sports
WPW
- EKG Findings (3)
- Treatment correct answers EKG Findings in WPW
, - Short PR Interval
- Narrow QRS
- Delta wave
Treatment: Procainamide
You are considering starting a RA / AI patient on TNF-alpha blocker. What 3 diseases do you
screen for? correct answers 1. Hep B
2. Hep C
3. TB
Lab Test to W/U Suspected HCV (3 Components) correct answers 1. ELISA for HCV
Antibody
+: Proceed to 2nd Immuno Based Assay (#2 below)
-: Not infected or very early infection
2. Immunobased Assay for HCV Antibody
+: Proceed to test for active / resolved infection (#3 below)
-: Original ELISA was a false+
3. HCV RNA PCR
+: Active Disease
-: Resolved disease
OCD:
- First Line Treatment (2)
- Alternative to First Line Rx Treatment correct answers - First Line Treatment
1. SSRI
2. Exposure-Response Therapy
- Alternative
1. Clomipramine
NHAP
- Why to think about different bugs?
- Inpatient vs. Outpatient Management correct answers NHAP: increase colonization of
oropharynx with GNR
Management
1. Inpatient: Cover MRSA (Vanc/Linezolid) and 2x Anti-Psuedomonal (Resp
Fluoroquinolone and Cephalosporin)
2. Outpatient: Resp Fluoroquinolone
1. Standard Management of Osteoporosis (3 components)
2. Rx that Decrease Hip Fractures (3)
3. Rx for Post-menopausal women with Osteoporosis and FMH of Breast Cancer
