Rosh Review family med exam
questions and answers 2024
possiblea
possiblea 8/7/24 Rosh
,A businessman, who frequently altitude changes. Symptoms include
travels in airplanes, complains of ear fullness, otalgia, tinnitus, hearing
painful ear popping every time he impairment and vertigo. Diagnosis is
flies. He has tried yawning, mainly clinical, but further evaluation
swallowing, chewing gum and may involve an audiogram,
pinching his nose, but nothing seems tympanogam or otolaryngologist
to relieve the pain. He has even tried referral. Treatment includes chewing
using ibuprofen two hours prior to gum, multiple swallows and
flight. exhalation through closed nostrils. If
refractory, medications may be
Which of the following would you
necessary, and include analgesics, oral
recommend?
antihistamines and nasal
decongestants or steroids.
A.Myringotomy Oxymetazoline is an over-the-counter
nasal spray decongestant.
B.Nifedipine
C.Oxymetazoline
A 26-year-old woman presents for her
D.Ranitidine - Correct Answer ( C ) annual exam and is inquiring about
Explanation: birth control. She is current on her
immunizations and her last pap smear
was 2 years ago. She is in a
Barotitis media, barotrauma, or ear monogamous relationship with her
popping, are all names for eustachian boyfriend and does not have any
tube dysfunction, a condition that immediate plans for pregnancy. She
occurs when the tube does not open has a history of migraines with aura
properly during swallowing or but does not require any prescription
yawning. This tube, connecting the medication.
middle ear to the pharynx, equalizes Which of the following birth control
pressure inside the ear to the methods is the best option for her?
atmospheric pressure. Blockage of the
tube can arise from congenital
stenosis, abnormal peristaltic A. Behavioral methods such as the
function, abnormal ciliary function, withdrawal method and periodic
adenoid hypertrophy, nasal congestion abstinence
and tumors. Risk factors include ear
or sinus infections, allergies and rapid
,B. Etonogestrel/ethinyl estradiol device, the injection or the
vaginal subcutaneous implantation in the arm.
C. Medroxyprogesterone acetate
D. Norelgestromin/ethinyl estradiol A 24-year-old woman with no past
transdermal - Correct Answer ( C ) medical history presents with left
wrist pain after a fall. The left
Explanation:
extremity is grossly deformed and the
patient complains of severe pain. The
Contraception counseling should be patient has a blood pressure of
routinely performed in all women of 183/100 mm Hg.
child-bearing age at every annual While awaiting X-rays, what
visit. There are many options such as management is indicated for the
behavioral, barrier and patients elevated blood pressure?
pharmacological methods. However,
pharmacological therapy has the
highest rate of pregnancy prevention A. Arrange admission for blood
and should be recommended in all pressure control
women, unless there are
B. Start an oral beta-blocker and
contraindications. This patient has a
monitor for response
history of migraines with aura which
is considered a contraindication to C. Start intravenous beta-blocker and
estrogen use. Other contraindications admit to the intensive care unit
to estrogen are history of deep vein D. Treat the patient's pain and reassess
thrombosis, breast cancer within the the blood pressure - Correct Answer (
past 5 years, cigarette smoking in D)
women more than 35 years of age
who smoke more than 15 cigarettes Explanation:
per day, ischemic heart disease,
stroke, active liver disease, major
surgery with prolonged The patient presents with a markedly
immobilization and poorly controlled elevated blood pressure in the setting
hypertension. In these cases, of pain from a trauma and should
progesterone only therapy have pain control initiated and her
(medroxyprogesterone) should be blood pressure rechecked.
used in the form of the intrauterine Hypertension is defined as a persistent
SBP >140 mm Hg or DBP >90 mm
, Hg. Pain and anxiety are common (C) Similarly, administration of an
causes of elevated blood pressure and intravenous beta-blocker and
heart rate in the outpatient setting. admission to the intensive care unit is
Historically, patients with elevated not indicated as the patient exhibits no
blood pressure and nonspecific end-organ damage.
symptoms were referred to as
hypertensive urgency but this term
has fallen out of use. In a patient Which of the following disorders
presenting with elevated blood causes a normal anion gap metabolic
pressure who does not have signs or acidosis?
symptoms of end-organ damage, the
clinician's focus should be on
identifying external reasons for the A. Cyanide exposure
elevated pressure and treating or B. Diabetic ketoacidosis
addressing these. In this case, the
reduction or relief of pain will likely C. Diarrhea
lead to decreased blood pressure. D. Salicylate ingestion - Correct
Answer ( C )
(A) Patients with elevated blood
pressure and an absence of end-organ Diarrhea is a common cause of
damage (e.g. acute coronary normal anion gap metabolic acidosis.
syndrome, aortic dissection, Metabolic acidosis is defined as a
encephalopathy, change in renal reduced serum bicarbonate
function) do not require admission for concentration. Normal anion gap
management. A primary care metabolic acidosis is thought to be
physician in the outpatient setting best less immediately dangerous than
manages these patients. anion gap metabolic acidosis. Normal
anion gap metabolic acidosis can be
caused by a variety of conditions
(B) Starting a beta-blocker will not be including rapid infusion of 0.9%
beneficial in a patient with acute pain saline, renal tubular acidosis,
as the cause of elevated blood ingestion of acetazolamide and
pressure. calcium chloride and
hypoaldosteronism.
