Jordan AbramsNBME Family Medicine Form 1 - Answers & Explanations
Updated: Jul 28, 2020
1) Median nerve entrapment • Paresthesia and pain in the first 31⁄2 digits = Carpal tunnel syndrome • Common during the third-trimester of pregnancy due to accumulation of fluid in the carpal tunnel; usually resolves following delivery
2) Mitral valve stenosis • Acute rheumatic fever → mitral regurgitation (early) and mitral stenosis (later)
• Diastolic murmur is consistent with mitral stenosis
3) Ask the wife to accompany her husband to his appointment and express her concerns in her husband’s presence
• The physician should speak with the couple in person so that the wife can express her concerns and so the husband can share his perspective
4) Calcium • Vegan diets lack calcium
5) Weight loss of 9 kg (20 lb) • Weight loss is the most effective non-pharmacologic measure to decrease blood pressure in patients with a BMI > 25 • Systolic pressure decreased 5-20 mm Hg for every 10kg lost
6) Oral griseofulvin for the patient only • Tinea capitis (most common in African American children) presents scaly erythematous patch with hair loss on scalp
• Tx: Oral griseofulvin or terbinafine
7) No, no, no • PPSV23 is given alone to adults <65 with other chronic medical conditions (eg, heart/lung/liver disease, diabetes) • Influenza vaccination should be given annually in the fall (not the spring)
8) Baroreceptor-mediated ADH (vasopressin) secretion • Exertional dyspnea, bilateral basilar crackles, S3 = CHF • CHF → ↓ ejection fraction → ↓ stimulation of baroreceptors → ADH secretion → fluid retention & hyponatremia
9) Keeping a log of ordered tests that require follow-up by the office
• Creates a system that will reduce the chances of delay in follow-up and care
• The patient should return for a follow-up visit. However, it is not the patients responsibility to identify the systemic communication error between the doctors office and the radiology facility.
10) Daily use of alcohol-acetic acid ear drops
• Acetic acid, when used after exposure to moisture, is an excellent prophylactic for otitis externa
11) Inhaled corticosteroid therapy • This patients asthma is not well controlled on an albuterol inhaler alone (step 1
therapy) → Low-dose inhaled corticosteroid should be added (step 2 therapy)
12) Fecal impaction
• Fecal impaction is common in older patients • Obstruction of fecal flow → backup of stool • Passage of liquid stool around impaction → loose stool/incontinence
13) Metformin • Elevated creatinine indicates diminished renal function • Metformin is nephrotoxic and should not be given to patients with renal failure as it increases risk of lactic acidosis
14) Provide symptomatic care only
• This patient likely has a viral URI
• Acute bacterial rhino sinusitis can be distinguishes from a viral URI by the presence of severe (eg, fever > 102 with purulent nasal discharge), persistent (>10 days with no improvement) or worsening symptoms (after initial improvement)
15) Abstinence from alcohol • Mildly elevated liver enzymes • Patients hasn’t traveled in a year - no carrier state with hepatitis A
16) Prescribe transdermal nicotine and recommend a behavior modification program
• Nicotine patches are not contraindicated in patients with angina pectoris
17) Topical selenium sulfide • Tinea versicolor (pityriasis versicolor) • Tx: topical ketoconazole, terbinafine, or selenium sulfide
18) Angiotensin-converting enzyme (ACE) inhibitor
• Drugs that improve long-term survival in patients with LV systolic dysfunction usually have some effect on the renin-angiotensin-aldosterone system (eg, β- blockers, ACEi)
• Diuretics will likely provide symptomatic relief, but will not improve chances of survival
19) Scheduling a follow-up examination with the patient
• Foster physician-patient relationship
20) Folic acid • Macrocytic anemia and ⊖ neurological exam
21) Change in knowledge and dietary habits of each participant • This study aimed to teach something (health benefits). Therefore the effectiveness of the program can be measure by a change in knowledge of the participants
22) The patient should not have access to car keys until her driving skills are formally assessed
• The family should ensure that the patient does not have access to care keys until a formal evaluation of her driving can be completed
• A physician can’t revoke a persons driver license (only the DMV can)
23) Serum Helicobacter pylori antibody assay • To narrow down the differential diagnosis in this patient (GERD vs peptic ulcer disease), H pylori infection should be ruled out
24) Continue his current regimen • Carotid endarterectomy should be considered for asymptomatic patients with carotid stenosis between 60-99%
25) Indomethacin
• NSAIDs are the preferred treatment for acute gouty arthritis
• Colchicine or glucocorticoids are recommended in patients with cirrhosis or CHF (NSAIDs are contraindicated)
• Urate-lowering drugs (eg, allopurinol) are indicated for patients with recurrent attacks or complicated disease (eg. Uric acid kidney stones)
26) Smoking cessation • There are multiple modifications that would benefit this patient, however, smoking cessation is the most beneficial
27) Exposure to human papillomavirus
• Most common cause of SCC in the perineal region is HPV infection
28) Recommend participation in a smoking cessation program
• COPD patients that smoke see a decrease in lung function at twice the rate compared to non-smoking COPD patients
• The only therapies proven to prolong survival in COPD patients are smoking cessation, supplemental O2, and lung reduction surgery
29) Enuresis alarm • This patient is a ‘deep sleeper’, therefore a bedwetting alarm would be best
30) Upper endoscopy • This older patient with a 20 year history of GERD and new alarm symptoms (eg, dysphagia/odynophagia) raises concern for esophageal adenocarcinoma
• Dx: Endoscopy with biopsy, CT scan for staging
31) Treatment of latent tuberculosis now
• ⊕PPD with a ⊖CXR = latent TB • Latent TB tx: Isoniazid + Pyridoxine
32) Reassurance • This patient shows signs of normal aging and does not require further evaluation
• Unaffected daily and executive functioning with a mini-mental exam score >26
33) Oral valacyclovir • CN V1 branch involvement with varicella zoster virus = herpes zoster opthalmicus
• Antiviral medication (eg, valacyclovir) → ↓ duration of symptoms & ↓ risk of postherpetic neuralgia
34) Varicocele • Scrotal mass (‘bag of worms’) • ↑ with standing or valsalva; ↓ in supine position
35) Warm saline gargle • Viral pharyngitis → supportive treatment