Family Medicine I - Q70-138 --- GOOD LUCK :)

70. Which of the following ECG abnormalities are shown in patient with Atrial Fibrillation:

71.You are evaluating a -year69-old man in the office who is complaining of irregular heart beat. Given his history and risk factors, you are concerned about Atrial fibrilation. Which of the following ECG features, if present, would suggest your dignosis?

72. A 41-year-old business executive presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 130 bpm. The most likely diagnosis is

73.You are seeing 57-year-old woman who is complaining of a “fluttering in her chest.” She is otherwise well, and denies shortness of breath or other acute symptoms. On examination, her pulse rate is rapid and irregular. Which of the following is her most likely diagnosis?

74.A 51-year-old man presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 115 bpm. The most likely diagnosis is

75.Which of the following is NOT considered a risk factor for MI?

76. A 49-year-old male smoker comes to his family doctor 7 days after a 4-hour bout of squeezing anterior chest pain that occurred while he was away with a group on a hunting trip, on which they traveled by canoe for 5 days away from their automobiles. He thought that he had a bout of heartburn; he has felt well since the attack and made the appointment “just in case.” His electrocardiogram (ECG) shows Q waves in leads II, III, and AVF but no ST deviation nor clearly abnormal T-wave patterns. There is no prior ECG with which to compare. Which of the following available laboratory tests would be the most sensitive and specific indicator of a myocardial infarction (MI) having occurred 7 days before?

77. A 49-year-old male smoker comes to his family doctor 7 days after a 4-hour bout of squeezing anterior chest pain that occurred during exercise. His electrocardiogram (ECG) shows Q waves in leads II, IIl, and AVF but no ST deviation. Which of the following available laboratory tests would be the most sensitive and specific indicator of a myocardial infarction (MI) having occurred 7 days before?

78. You are evaluating a patient with chest pain in the emergency department. The ECG shows no Q waves or ST-segment changes. You wish to know whether the patient is suffering a myocardial infarction. Which of the following biomarkers is the preferred biochemical marker of myocardial infarction

79. You are evaluating a 61-year-old man in the office who is complaining of chest pain. Given his history and risk factors, you are concerned about myocardial ischemia, and order an ECG. Which of the following ECG features, if present, would most markedly increase the likelihood of an acute myocardial infarction?

80. You are evaluating a 69-year-old man in the office who is complaining of chest pain. Given his history and risk factors, you are concerned about myocardial ischemia. Which of the following ECG features, if present, would most markedly increase the likelihood of an acute myocardial infarction?

81. A 57-year-old woman presents to the hospital with a 2-hour history of retrosternal chest pain and dyspnea. Her electrocardiogram (ECG) reveals an acute myocardial infarction pattern. Which of the following ECG patterns is consistent with that interpretation?

82. A 68-year-woman with hypertension and dyslipidemia presents with 30 minutes of retrosternal chest pain radiating to her neck. She is diaphoretic and in moderate distress. The ECG shows ST-segment elevation in the inferior leads. Which of the following mechanisms is the most likely cause of her condition?

83. A 75-year-old man comes into the emergency department with a 10-minute history of crushing substernal chest pain radiating to his left arm. This man is well known to the staff due to his long history of chest pain. His creatine phosphokinase level is elevated and his troponin T level is 0.4 g/mL. Which of the following is the most likely diagnosis?

84. You are evaluating a 40-year-old male patient in the office who is complaining of chest pain. His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?

85. A 87-year-old woman presents to the emergency department with a chief complaint of shortness of breath over the past 2 days. She has a history of hypertension and coronary artery bypass surgery 25 years earlier. Her blood pressure is 178/92 mm Hg and she has jugular venous distension, hepatomegaly, and 3+ lower extremity edema. ECG is remarkable for left ventricular hypertrophy, no ST-segment elevations or depressions, no Q waves, and no Twave abnormalities. Echocardiogram reveals an ejection fraction of 60% and left atrial dilatation. There is universal left ventricular thickening. No valvular regurgitation or stenosis was noted. Which of the following underlying conditions is the most likely cause of this patient's symptoms?

86. A 63-year-old man with a history of hypertension and hyperlipidemia comes to the emergency department complaining of 1 hour of chest pain that came on at rest. The pain is substernal and radiates to both shoulders. He describes the pain as “diffuse pressure, not sharp” and says he feels nauseated and sweaty. He also feels like the pain improves when he curls up on his left side. His physical examination is notable only for some mild diaphoresis and a heart rate of 105 bpm with blood pressure of 140/ 88 mmHg. All of the following aspects of his history increase the likelihood of acute coronary syndrome EXCEPT:

87. Mr. Gilotra is a 57-year-old oil rig worker with a history of hypertension, tobacco abuse, and diabetes mellitus. He presents to the emergency department with 30 minutes of crushing substernal chest pain radiating to the jaw and associated with profuse sweating and shortness of breath. His blood pressure is 115/90 mmHg, and heart rate is 95 bpm. What diagnostic test will provide the most rapid method of altering therapeutic management for Mr. Gilotra?

88. A 55 year-old-man has pain in his left leg during walking which began 6 month ago. He does not have chest pain, shortness of breath, palpitations or syncope. Medical history is unremarkable. He takes no medications. He is an ex-smoker with a 20 pack-year history. Patient does not use alcohol or illicit drugs. His father died at age 65 from MI. BP is 147/95mm, pulse 83 regular. Cardiac, pulmonary and abdominal examination are within normal limits. Peripheral pulses are decreased in the left leg. Ankle-brachial index is 0.65 in the left leg and 1,1 in the right. ECG-normal. Fasting glucose-normal, Cholesterol 220 mg/dl, HDL 50 mg/dI, LDL 135mg/dl, Triglycerides 150mg/dl. Which is the most appropriate next step in this patient?

89. Which of the following medications would improve survival following an MI

90. Which of the following medications would improve survival following an MI

91. You have diagnosed a 49-year-old man with CHF because of left ventricular systolic dysfunction. In addition to acute diuresis, which of the following is the best list-line agent to use for treatment, in the absence of contraindications?

92. Which of the following combinations would be best utilized in the treatment of diastolic heart failure?

93. Which of the following is definition of hypertension?

94.Which of these patients need treatment for hypertension? (UNC-7)

95. Which of the following disease may cause a secondary arterial hypertension?

96. Which of the following disease may cause a secondary arterial hypertension?

97. Which of the following disease may cause a secondary arterial hypertension

98. Which of the following tests is considered routine (recommended) in the initial evaluation of a patient with hypertension?

99. Which of the following tests is considered routine (recommended) in the initial evaluation of a patient with hypertension?

100. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

101. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

102. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

103. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

104. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure ?

105. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

106. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?

107. All of the following interventions are important for reduction of high blood pressure except

108. A 39-year-old white man with essential hypertension presents for a routine health maintenance visit. He has no complaints and reports compliance with his hydrochlorothiazide. His pulse is 70/min, blood pressure is 145/92 mm Hg, and respiratory rate is 16/min. His body mass index is 24 kg/m2 . His physical examination is within normal limits. For which condition is the patient at increased risk?

109. A 53-year-old with type 2 diabetes mellitus is found to have a blood pressure of 152/98. She has never had any ophthalmologic, cardiovascular, or renal complications of diabetes or hypertension (HTN). Based on recent recommendations of the JNC 7 (The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) which of the following is the currently recommended goal for blood pressure control in this case?

110. A 28-year-old woman has hypertension that is difcult to control. She was diagnosed at age 26. Since that time, she has been on increasing amounts of medication. On physical examination, she appears to be without distress. Blood pressure is 168/100 mmHg, and heart rate is 84 bpm. Cardiac examination is unremarkable, without rubs, gallops, or murmurs. She has good peripheral pulses and no edema. Her physical appearance does not reveal any hirsutism, fat maldistribution, or abnormalities of genitalia. Laboratory studies reveal a potassium of 2.8 mE/dL and a serum bicarbonate of 32 mE/dL. Fasting blood glucose is 105 mg/dL

111. Which of following is false with regard to medical therapy of hypertension?

112. Despite lifestyle changes, a 37-year-old patient of yours still has blood pressures above goal. She has no other medical concerns and no abnormalities on physical examination or initial laboratory evaluation. Which of the following medications is best as an initial first-line monotherapy, according to the Joint National Committee 7 (JNC 7)?

113. You are seeing a 47-year-old hypertensive patient in your office. He is wellcontrolled with hydrochlorothiazide and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76 mm Hg. Laboratory evaluation reveals a normal creatinine but he does have A1c 7.2. Which of the following interventions is indicated in this patient?

114. You are seeing a 43-year-old hypertensive patient in your office. He is well-controlled with hydrochlorothiazide and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76 mm Hg. Laboratory evaluation reveals a normal creatinine and a GFR greater than 90 mL/min, but he does have microalbuminuria. Which of the following interventions is indicated in this patient?

115. You have diagnosed a 35-year-old African-American man with hypertension. Lifestyle modifications helped reduce his blood pressure, but he was still above goal. You chose to start hydrochlorothiazide, 25 mg daily. This helped his blood pressure, but it is still 142/94 mm Hg. Which of the following is the best approach to take in this situation?

116. A 63-year-old woman has Type II diabetes mellitus, which is well-controlled. Her physical examination is positive for peripheral neuropathy in the feet and nonproliferative retinopathy. A urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?

117. 63 years old woman with DM type 2, which is small controlled. Her physical examination is positive for peripheral neuropathy in the feet and non-proliferative retinopathy. Urinalysis is positive for proteinuria. One of the following treatments is positive for attenuate the course of renal disease:

118. A 55-year-old man comes to your office after not being seen by a physician in more than 10 years. He is found to be hypertensive, and his creatinine is found to be 2.3 mg/dL (H). Which medication is most likely to control his blood pressure and decrease the likelihood of progression of his renal disease?

119. A 51-year-old white man recently relocated to the area and presents to your office as a new patient. He denies having any history of medical problems. He made very infrequent visits to a primary care provider where he previously lived. He is on no medicines and denies having any significant family medical history. He is a current smoker with a 40 pack-year smoking history. His blood pressure is 170/95 mm Hg, and a fourth heart sound is present. His physical examination is otherwise unremarkable. Which of the following statements regarding treatment of this patient's hypertension is true?

120. A 38-year-old African-American man is evaluated for the new diagnosis of hypertension. His workup has shown multiple elevated blood pressure readings in the past few months but no evidence of any other medical conditions. You plan to initiate an antihypertensive medication. Which of the following would be the best initial choice?

121. A 64-year-old black man presents to your office for routine follow-up care. You have treated him for many years for hypertension with a calcium channel blocker and a thiazide diuretic. His hypertension has been moderately well controlled with this regimen. He asks you whether having a home blood pressure monitor would be useful for his care. Which of the following statements regarding ambulatory blood pressure monitoring (ABPM) is true?

122. You have seen a 36-year-old man with elevated blood pressure. On one occasion, his blood pressure was 163/90 mm Hg, and on a second occasion, his blood pressure was 158/102 mm Hg. You have encouraged lifestyle modifications including weight loss using exercise and dietary changes. Despite some modest weight loss, at his current visit, his blood pressure is 166/92 mm Hg. Which of the following is the best treatment strategy at this point?

123. A 36-year-old woman has a history of hypertension and is planning on starting a family. She is currently taking lisinopril 10 mg daily for control of her blood pressure. She wants to stop taking her oral contraceptive medications. Her current blood pressure is 128/83 mmHg. What do you advise her about ongoing treatment with antihypertensive medications?

124. You are evaluating a 56 year-old obese woman who complains of fatigue. She has polydipsia, polyuria, polyphagia. Which of the following laboratory reports confirms the diagnosis of diabetes?

125. You are evaluating a 36-year-old obese woman who complains of fatigue. She denies polydipsia, polyuria, polyphagia, or weight loss. Which of the following laboratory reports confirms the diagnosis of diabetes?

126. A 52-year-old obese man presents for follow-up of his hypertension. His blood pressure is well controlled on a daily dose of hydrochlorothiazide. A finger-stick blood sugar test done an hour after he ate lunch was 130 mg/ dL. Which of the following test results would be diagnostic for diabetes mellitus?

127. You are performing a screening physical examination on a 47-year-old man. He is generally healthy, and his review of systems is negative. His mother has type 2 diabetes, and he is overweight. Which of the following is generally accepted as the test of choice to screen for type 2 diabetes?

128. Which of the following is correct about hyperosmolar hyperglycemic state HHS:

129. A 57-year-old man complains of increased thirst and urination. His examination is normal. Which of the following is the most appropriate initial diagnostic test?

130. A 46-year-old woman with a 10-year history of insulin-requiring diabetes mellitus presents to the emergency room with nausea, vomiting, and abdominal pain. Family members state that the patient has recently been taking over-the-counter medications for an upper respiratory tract infection. The blood pressure is 90/60 mm Hg and the pulse is 120/min. The patient is lethargic but follows commands. Pupils are 3 mm bilaterally and reactive to light and accommodation. Abdominal examination reveals diffuse tenderness but no rebound tenderness. Neurologic examination reveals no focal deficits. Finger stick glucose is >800 mg/dL and arterial blood gas reveals a pH of 7.36. Which of the following is the most likely diagnosis?

131. A 39-year-old G1P0 woman who is a new patient presents to the office at 10 weeks' gestation. She is known to have type 2 diabetes mellitus and currently takes metformin. Her BMI of 34.7. This patient is at an increased risk for developing which of the following?

132. A 53-year-old woman with type 2 diabetes mellitus is found to have a blood pressure of 152/98. She has never had any ophthalmologic, cardiovascular, or renal complications of diabetes or hypertension (HTN). Based on recent recommendations of the JNC7 (The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) which of the following is the currently recommended goal for blood pressure control in this case?

133. A 34-year-old man was diagnosed with type 2 diabetes mellitus as a child and has been presenting for annual examinations since he was in his early 20s. Which of the following screening tests is indicated more than once a year

134. In which of the following categories should women undergo routine screening for gestational diabetes?

135. A 50-year-old woman is diagnosed with type 2 diabetes mellitus. Her hemoglobin A1C is now 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and no other medical conditions. Which of the following is the most appropriate first-line therapy?

136. A 53-year-old woman's A1C is 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and her LDL is 120mg/dL. Which of the following is the most appropriate first-line therapy?

137. Patient with newly established diagnosis of type 2 diabetes mellitus. Along with diet and exercise, which of the following is the most appropriate initial management?

138. A 49-year-old woman presents to her physician's office with a long-standing history of polydipsia, polyuria, central obesity, and hyperlipidemia. She is currently taking metformin, a sulfonylurea, and an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are most beneficial in preventing or slowing the progression of which of the following diabetic complications?

139. A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning hair. You suspect hypothyroidism and order the appropriate laboratory tests. Her TSH is high, and her free T 3 and free T 4 are both low. Which of the following is the most likely diagnosis?