Family Practice Exam Flashcards

If a patient with low back pain exhibits any of the following symptoms:

Answer: All of the above

All the listed symptoms are 'red flags' in patients with low back pain, indicating a need for further evaluation or specialist referral. Herniated nucleus pulposus (HNP) with major muscle weakness suggests significant nerve compression, while chronic sciatica or new neurological deficits point to ongoing or worsening nerve involvement. Recurrent back pain, especially with these other symptoms, warrants a thorough investigation to rule out serious underlying conditions.

A patient is admitted with whiplash. The patient exhibits paresthesia along the spine when the neck is flexed, according to the examination. This is advantageous:

Answer: Lhermitte sign

The Lhermitte sign is a neurological finding characterized by an electric shock-like sensation that radiates down the spine and into the extremities upon neck flexion. This sign is indicative of cervical spinal cord dysfunction or demyelination, often seen in conditions like whiplash, multiple sclerosis, or cervical spondylosis. Its presence suggests potential spinal cord irritation or damage.

Symptoms of mild acne in a 17-year-old girl include papules, pustules, and a few nodules. Benzoyl peroxide purchased over the counter, which she had been using, is no longer effective. Which line treatment works the best?

Answer: Topical erythromycin 3% + 5% benzoyl peroxide

For mild acne that is no longer responding to over-the-counter benzoyl peroxide, combining a topical antibiotic like erythromycin with benzoyl peroxide is an effective next step. The antibiotic targets the bacteria (P. acnes) contributing to inflammation, while benzoyl peroxide helps unclog pores and has additional antimicrobial effects. This combination often reduces antibiotic resistance and improves treatment outcomes for moderate acne.

With a patient with stage 3 chronic renal disease, how should hypertension be treated?

Answer: Use angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), and loop diuretics in combination

In patients with Stage 3 chronic renal disease and hypertension, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are crucial for blood pressure control and renoprotection. Loop diuretics are often necessary to manage fluid balance and hypertension as kidney function declines. Combining these agents helps achieve target blood pressure and slow the progression of kidney disease.

A patient with severe right upper quadrant (RUQ) pain presents. Which imaging test should be used to evaluate this patient?

Answer: Ultrasound (US)

For a patient presenting with severe right upper quadrant (RUQ) pain, an ultrasound (US) is the initial imaging modality of choice. It is non-invasive, readily available, and highly effective at visualizing the gallbladder, bile ducts, and liver. This makes it ideal for diagnosing common causes of RUQ pain such as gallstones, cholecystitis, or liver abnormalities.

A 44-year-old patient with hypertension has an electrocardiogram (ECG) ordered by the doctor. Left ventricular hypertrophy is visible on the ECG (LVH). Which of these results might the doctor be anticipating from this ECG?

Answer: A tall R wave in V6, a deep S in V1, inverted T waves in V5 and V6, and left axis deviation

Left Ventricular Hypertrophy (LVH) on an ECG is typically characterized by increased voltage criteria, such as a tall R wave in left-sided leads (V5, V6) and a deep S wave in right-sided leads (V1, V2). Additionally, repolarization abnormalities like inverted T waves in V5 and V6 (often called a 'strain pattern') and left axis deviation are common findings associated with LVH due to the increased muscle mass.

The fasting lipid profile of a 46-year-old male reveals a total cholesterol level of 238 mg/dL and an HDL-C level of 185. He has smoked for 100 pack-years. He falls into the moderately high risk category (10-year risk = 10-20%), according to the Framingham Coronary Risk Calculator. Less LDL cholesterol is the desired value for this patient.

Answer: 130 mg/dL

For a patient with a moderately high risk (10-year risk = 10-20%) of coronary heart disease, as determined by the Framingham Coronary Risk Calculator, the desired LDL cholesterol target is typically less than 130 mg/dL. This target aims to reduce their cardiovascular risk, especially given their significant smoking history and elevated total cholesterol. More aggressive targets are usually reserved for higher-risk individuals.