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Rosh Review family med questions and answers rated A+ 2024/2025
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Rosh Review family medA businessman, who regularly travels in airplanes, complains of painful ear popping every time
he flies. He has attempted yawning, swallowing, chewing gum and pinching his nose, but not
anything appears to alleviate the ache. He has even tried the usage of ibuprofen two hours prior
to flight.
Which of the following would you advocate?
A.Myringotomy
B.Nifedipine
C.Oxymetazoline
D.Ranitidine - ANSCorrect Answer ( C )
Explanation:
Barotitis media, barotrauma, or ear popping, are all names for eustachian tube dysfunction, a
circumstance that happens whilst the tube does not open nicely at some point of swallowing or
yawning. This tube, connecting the center ear to the pharynx, equalizes pressure within the ear
to the atmospheric strain. Blockage of the tube can stand up from congenital stenosis, abnormal
peristaltic function, odd ciliary feature, adenoid hypertrophy, nasal congestion and tumors. Risk
factors include ear or sinus infections, allergic reactions and fast altitude changes. Symptoms
include ear fullness, otalgia, tinnitus, listening to impairment and vertigo. Diagnosis is especially
medical, however similarly evaluation may additionally contain an audiogram, tympanogam or
otolaryngologist referral. Treatment includes chewing gum, a couple of swallows and exhalation
through closed nostrils. If refractory, medicinal drugs can be essential, and consist of
analgesics, oral antihistamines and nasal decongestants or steroids. Oxymetazoline is an over
the counter nasal spray decongestant.
A 26-yr-old girl presents for her annual examination and is inquiring approximately start
manipulate. She is cutting-edge on her immunizations and her last pap smear was 2 years in
the past. She is in a monogamous relationship along with her boyfriend and does no longer
have any immediate plans for pregnancy. She has a history of migraines with air of mystery but
does now not require any prescription remedy.
Which of the subsequent start control methods is the pleasant option for her?
A. Behavioral techniques including the withdrawal technique and periodic abstinence
B. Etonogestrel/ethinyl estradiol vaginal
C. Medroxyprogesterone acetate
D. Norelgestromin/ethinyl estradiol transdermal - ANSCorrect Answer ( C )
Explanation:
Contraception counseling should be automatically finished in all ladies of toddler-bearing age at
every annual go to. There are many options such as behavioral, barrier and pharmacological
,techniques. However, pharmacological therapy has the highest charge of being pregnant
prevention and have to be endorsed in all ladies, except there are contraindications. This patient
has a records of migraines with air of mystery which is taken into consideration a
contraindication to estrogen use. Other contraindications to estrogen are records of deep vein
thrombosis, breast cancer within the past five years, cigarette smoking in ladies more than 35
years of age who smoke more than 15 cigarettes in step with day, ischemic coronary heart
disease, stroke, energetic liver ailment, essential surgery with prolonged immobilization and
poorly managed hypertension. In those cases, progesterone handiest remedy
(medroxyprogesterone) ought to be used inside the shape of the intrauterine tool, the injection
or the subcutaneous implantation within the arm.
A 24-12 months-old lady with no past clinical history affords with left wrist pain after a fall. The
left extremity is grossly deformed and the affected person complains of severe pain. The patient
has a blood strain of 183/100 mm Hg.
While awaiting X-rays, what control is indicated for the patients multiplied blood strain?
A. Arrange admission for blood stress control
B. Start an oral beta-blocker and display for response
C. Start intravenous beta-blocker and admit to the extensive care unit
D. Treat the affected person's ache and reassess the blood pressure - ANSCorrect Answer ( D )
Explanation:
The affected person gives with a markedly multiplied blood stress in the putting of pain from a
trauma and should have pain control initiated and her blood strain rechecked. Hypertension is
described as a chronic SBP >one hundred forty mm Hg or DBP >90 mm Hg. Pain and anxiety
are not unusual reasons of extended blood stress and coronary heart fee within the outpatient
setting. Historically, patients with improved blood stress and nonspecific symptoms have been
known as hypertensive urgency but this term has fallen out of use. In a affected person
providing with improved blood pressure who does not have signs or symptoms of cease-organ
damage, the clinician's focus have to be on figuring out outside motives for the expanded strain
and treating or addressing these. In this case, the reduction or comfort of pain will in all
likelihood lead to reduced blood stress.
(A) Patients with extended blood pressure and an absence of give up-organ harm (e.G. Acute
coronary syndrome, aortic dissection, encephalopathy, change in renal characteristic) do no
longer require admission for control. A number one care health practitioner in the outpatient
setting pleasant manages these sufferers.
(B) Starting a beta-blocker will no longer be beneficial in a patient with acute ache because the
reason of multiplied blood stress.
(C) Similarly, management of an intravenous beta-blocker and admission to the intensive care
unit isn't indicated because the affected person reveals no quit-organ harm.
,Which of the following disorders reasons a normal anion hole metabolic acidosis?
A. Cyanide exposure
B. Diabetic ketoacidosis
C. Diarrhea
D. Salicylate ingestion - ANSCorrect Answer ( C )
Diarrhea is a commonplace reason of everyday anion hole metabolic acidosis. Metabolic
acidosis is described as a discounted serum bicarbonate awareness. Normal anion gap
metabolic acidosis is concept to be much less immediately dangerous than anion hole metabolic
acidosis. Normal anion hole metabolic acidosis may be resulting from a spread of conditions
together with rapid infusion of zero.Nine% saline, renal tubular acidosis, ingestion of
acetazolamide and calcium chloride and hypoaldosteronism.
Cyanide (A), diabetic ketoacidosis (B) and salicylate ingestion (D) are all reasons of elevated
anion gap metabolic acidosis.
A fifty eight-12 months-old guy gives with three months of headache and diplopia. He also
reviews that chewing difficult foods has been progressively painful. Laboratory checking out
well-knownshows a normocytic anemia and ESR of 88 mm/hour. A brain CT is normal. Which of
the following is the maximum suitable preliminary intervention?
A. Intravenous methylprednisolone
B. Oral methotrexate
C. Temporal artery biopsy
D. Ultrasonography - ANSCorrect Answer ( A )
Giant cell arteritis (GCA), as known as temporal arteritis, is the maximum not unusual number
one vasculitis of the aged, and predominately influences the ones aged over 50 years. It is a
syndrome of systemic irritation which specially affects the branches of the inner and outside
carotid arteries, however it may have an effect on any vessel in the frame. The most not unusual
symptoms are a temporal or occipital headache, jaw claudication (mandibular, enamel and
tongue pain with chewing tough foods), visible changes (partial or entire blindness, diplopia,
visual view cuts or amaourosis fugax) and arthralgias. It is associated with constitutional signs,
anemia, an enlarged smooth nodular erythematous temporal artery, ESR > 50 mm/hour and
polymyalgia rheumatica. Temporal artery biopsy confirms the prognosis. Since unilateral partial
or whole blindness takes place in up to 20% of patients with GCA, immediately treatment is
important when this circumstance is suspected. High-dose corticosteroids are the same old
treatment, and usual alternatives include 40-60 mg in keeping with day of oral prednisone, or
intravenous methylprednisolone. High-dose remedy is typically persevered for two-4 weeks, and
titrated against visual and headache development, now not serial ESR tracking. After symptoms
reduce, steroids are slowly tapered over 6 months, with complete tapering off in 2 to a few
years. As such, the clinician have to display for complications of long-time period corticosteroid
therapy. These encompass hypertension, diabetes, osteoporosis, steroid myopathy (proximal
, weak point), fluid retention, bruising, insomnia, restlessness, hypomania and
hypercholesterolemia.
Adjuvant methotrexate (B) isn't automatically recommended for treating GCA as studies of its
efficacy are inconclusive. If GCA is suspected, intravenous methylprednisolone must be started
out even earlier than a temporal bio
A 33-12 months-vintage lady and not using a medical troubles provides with chest pain and
shortness of breath. The signs worsened over the previous two days and boom with exertion.
The affected person denies cough, however ultimate week reports fevers, chills, coughing and
myalgias. Her ECG demonstrates sinus tachycardia without ST segment modifications. Vital
signs are T 100.7°F, HR 120, BP 108/60, RR 16, a hundred% saturation on room air. Which of
the subsequent is the maximum likely analysis?
AAcute coronary syndrome
BMediastinitis
CMyocarditis
DPulmonary embolism - ANSCorrect Answer ( C )
Explanation:
Myocarditis is usually because of a viral contamination, most usually coxsackie B virus,
adenovirus, parvovirus B19 and Echovirus. Trypanasoma cruzi (Chagas disease) is the most
commonplace etiology worldwide. Myocardial necrosis takes place possibly as a result of direct
invasion of the offending organism as well cytotoxic results of the host's immune device.
Individuals broaden flulike signs and in adults chest pain and shortness of breath. One of the
hallmark signs and symptoms of myocarditis is tachycardia out of share to fever. Depending at
the time of presentation, patients can also have signs and symptoms of heart failure because
the left ventricular ejection fraction is impaired due to the myocarditis. Troponin is frequently
improved because the sickness progresses. The gold general for prognosis is endocardial
biopsy. Management is supportive. ACE inhibitors help lessen myocardial inflammation.
Acute coronary syndrome (A) is a possibility on this affected person but is much less likely given
her age and absence of clinical history. It is likewise peculiar for a person with acute coronary
syndrome to have a fever and viral symptoms. Mediastinitis (B) may additionally present with
fever, chest pain and shortness of breath. However, there is mostly a history of either severe
retching or a manner that caused esophageal perforation. Patients with air inside the
mediastinum from a perforation may have Hamman's sign, a crunching sound on auscultation.
Pulmonary embolism (D) does reason chest pain and shortness of breath. Classically the chest
ache is pleuritic and flulike signs are not related to the diagnosis. Patients with a pulmonary
embolism may additionally have a low-grade fever.
A fifty two-12 months-vintage guy with a records of high blood pressure affords with a situation
that he's "developing breasts." On exam, glandular growth underneath his areola is present
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