Family Medicine 2023_2024 Review
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A 52-year-old female sees you because of a vaginal discharge. An examination reveals a
malodorous, greenish-yellow, frothy discharge, and inflammation of the cervix and vagina.
Which one of the following is the most likely diagnosis?
A) Atrophic vaginitis
B) Irritant/allergic vaginitis
C) Bacterial vaginosis
D) Trichomoniasis
E) Vulvovaginal candidiasis ANSWER: D
Trichomoniasis classically presents as a greenish-yellow, frothy discharge with a foul odor.
Erythema and inflammation of the vagina and cervix are often present and can include punctate
hemorrhages (strawberry cervix). Atrophic vaginitis may cause a thin, clear discharge and is
usually associated with a thin, friable vaginal mucosa. Irritant/allergic vaginitis causes burning
and soreness with vulvar erythema but usually does not cause any significant discharge. Bacterial
vaginosis more commonly presents as a thin, homogenous discharge with a fishy odor and no
cervical or vaginal inflammation. Vulvovaginal candidiasis presents with white, thick, cheesy, or
curdy discharge.
A previously healthy 45-year-old female presents with upper abdominal pain and dysphagia. An
upper GI series reveals no significant reflux. On esophagogastroduodenoscopy the esophagus has
a ringed appearance and a biopsy reveals >15 eosinophils/hpf. Helicobacter pylori testing is
negative. She does not currently take any medications.
Which one of the following would be the best initial treatment?
A) Budesonide oral suspension, 1 mg twice daily
B) Fexofenadine, 180 mg daily
C) Pantoprazole (Protonix), 40 mg once daily
D) Prednisone, 40 mg daily for 7 days
,E) Ranitidine (Zantac), 150 mg once daily The clinical presentation and
esophagogastroduodenoscopy findings indicate eosinophilic esophagitis (EoE) in this patient. In
the absence of other causes of eosinophilia, the presence of >15 eosinophils/hpf is considered
diagnostic. Application of corticosteroids to the esophagus is generally the treatment of choice,
either in the form of an oral suspension of budesonide or an inhaled corticosteroid sprayed into
the mouth and swallowed.
A healthy 55-year-old white male with a family history of coronary artery disease sees you for a
routine health maintenance visit. He asks you what he could do to decrease his risk of
cardiovascular disease. He is a nonsmoker, does not drink alcohol, and has no history of
substance abuse. His BMI is normal and the physical examination is otherwise unremarkable.
His vital signs include a heart rate of 80 beats/min, a blood pressure of 119/70 mm Hg, a
respiratory rate of 15/min, and a temperature of 37.0°C (98.6°F).
Laboratory Findings
Fasting glucose....................................................92 mg/dL
Total cholesterol..................................................190 mg/dL
LDL-cholesterol...................................................98 mg/dL
HDL-cholesterol ..........................................................50 mg/dL
Triglycerides ......................................................... ANSWER: A
A systematic evidence review released by the U.S. Preventive Services Task Force (USPSTF)
noted that the most active people had median cardiovascular risk reductions of about 30%-35%
when compared with the least active. Statins are beneficial for both primary and secondary
prevention of cardiovascular disease, but the benefit is greater when the baseline risk is greater.
Current guidelines would not support statin therapy for a patient with a 10-year risk of
atherosclerotic cardiovascular disease (ASCVD) <5%. Fish oil supplements have not proven to
be useful for primary prevention of ASCVD. Aspirin is recommended for the prevention of
cardiovascular disease in adults 50-59 years of age with a >10% 10-year ASCVD risk who are
not at increased risk of bleeding, are expected to live at least 10 years, and are willing to take
low-dose daily aspirin for 10 years (USPSTF B recommendation). Niacin is no longer
recommended for cardiovascular risk reduction due to a lack of evidence for benefit.
The physical examination is notable only for a BMI of 36.0 kg/m2 . Laboratory findings are
notable for significant hyperlipidemia and you recommend starting a statin. She reports that she
will undergo an elective total knee replacement next month and asks about the safety of starting a
new medication before this surgery.
You recommend that she
A) start a statin immediately to decrease her risk of cardiovascular disease and perioperative
mortality
B) start a statin immediately to decrease her risk of cardiovascular disease, although her risk of
perioperative mortality will not be affected
C) start a statin immediately to decrease her risk of cardiovascular disease, stop the statin 1 week
before surgery, and resume taking it after the surgery, to decrease her risk of perioperative
mortality
,D) start a statin immediately after the surgery to decrease her risk of cardiovascular disease and
perioperative mortality Answer A:
Family physicians are often consulted for perioperative medical management. Studies have
shown decreased perioperative mortality in patients who continue statins and in patients with
clinical indications for statin therapy who start statins prior to undergoing vascular or high-risk
surgeries such as joint replacement. A meta-analysis of 223,000 patients showed a significant
reduction in perioperative mortality in patients receiving statin therapy versus placebo who
underwent noncardiac surgical procedures. This patient has a clinical indication (multiple risk
factors) to start statin therapy now.
Which one of the following is the greatest risk factor for abdominal aortic aneurysm (AAA)?
A) Male sex
B) Female sex
C) White race
D) A long duration of smoking
E) Having a first degree relative with an AAA ANSWER: D
The following factors have been found to increase the risk for developing an abdominal aortic
aneurysm (AAA): a history of smoking, advanced age, above-average height, having a first
degree relative with an AAA, a personal history of atherosclerosis, high cholesterol levels, and
hypertension. Smokers have a seven times greater risk of developing an AAA compared with
nonsmokers. This single factor outweighs all of the other risk factors except age. Although
women are less likely to develop an AAA, they have a 2-3 times greater chance of an AAA
rupturing if it is present.
In addition to significantly increasing the risk for AAA development, current smoking increases
the risk for further AAA expansion and rupture. Epidemiologic studies suggest that the duration
of smoking influences the risk for AAA significantly more than the total number of cigarettes
smoked. The U.S. Preventive Services Task Force currently recommends one-time screening for
AAA in males between the ages of 65 and 75 who have ever smoked (B recommendation). There
was not enough evidence to determine the risk and benefits of screening females with the same
risk factors (I recommendation).
sarcoidosis - EKG --> mgt Type II second degree AV block
According to the most recent American College of Cardiology/American Heart Association
guidelines, hypertension is defined as a blood pressure reading greater than - The latest
ACA/AHA guidelines promote a radical change in the management of hypertension, which they
now define as a blood pressure ≥ 130/80 mm Hg.
- Elevated blood pressure is defined as a systolic pressure of 120-129 mm Hg and a diastolic
pressure <80 mm Hg.
- A blood pressure of 130-139/80-89 mm Hg is classified as stage 1 hypertension and a systolic
pressure ≥ 140 mm Hg or a diastolic pressure ≥90 mm Hg is classified as stage 2 hypertension.
- The 2017 ACC/AHA guidelines recommend drug therapy for all patients with an average blood
pressure >130 mm Hg systolic or >80 mm Hg diastolic despite a trial of lifestyle modification.
, -The 2017 ACC/AHA guidelines recommend drug therapy for all patients with an average blood
pressure >130 mm Hg systolic or >80 mm Hg diastolic despite a trial of lifestyle modification
An otherwise asymptomatic 7-year-old male has a blood pressure above the 95th percentile for
gender, age, and height on serial measurements. Which one of the following studies would be
most appropriate at this time?
A) Renin and aldosterone levels
B) 24-hour urinary fractionated metanephrines and normetanephrines
C) Renal ultrasonography
D) Doppler ultrasonography of the renal arteries
E) A sleep study - Answer C
- Renal parenchymal diseases such as glomerulonephritis, congenital abnormalities, and reflux
nephropathy are the most common cause of hypertension in preadolescent children.
Preadolescent children with hypertension should be evaluated for possible secondary causes and
renal ultrasonography should be the first choice of imaging in this age group.
Hypertension by age
Signs and symptoms that suggest that specific 2ndary causes of htn.
Wolf Parkinson White Syndrome (WPW) treatment
A) Adenosine (Adenocard)
B) Amiodarone (Cordarone)
C) Diltiazem (Cardizem)
D) Metoprolol
E) Catheter ablation - Catheter ablation is the most appropriate treatment for a patient with
symptomatic Wolff-Parkinson-White syndrome (WPW). Catheter ablation has a very high
immediate success rate (96%-98%).
- The most significant risk associated with the procedure is permanent atrioventricular block,
which occurs in approximately 0.4% of procedures.
- Adenosine and amiodarone are used for the acute management of supraventricular tachycardia,
but not for long-term management.
Three weeks after he had knee surgery, a 64-year-old male presents for follow-up of an
emergency department visit for a pulmonary embolism. He has no previous history of pulmonary
embolism and is otherwise in good health. He is being treated with apixaban (Eliquis).
The recommended duration of anticoagulation therapy for this patient is:
A) 1 month
B) 3 months
C) 6 months
D) 9 months
E) 12 months B)
