AARP Family medicine #2-
Latest Update- 91 Questions
and 100% Correct Answers
A 52-year-old male has a skin lesion removed from his arm with
appropriate sterile precautions.
Which one of the following would be most appropriate to use on this
surgical wound? - -The American Academy of Dermatology recommends
against the routine use of topical antibiotics for clean
surgical wounds, based on randomized, controlled trials. Topical
antibiotics have not been shown to reduce
the rate of infection in clean surgical wounds compared to the use of
nonantibiotic ointment or no ointment.
Studies have shown that white petrolatum ointment is as effective as
antibiotic ointment in postprocedure
care.
use petrolatum
-A 23-year-old female presents with recurrent unprovoked epistaxis.
The patient's mother is known to have hereditary hemorrhagic
telangiectasia.
Contrast echocardiography is recommended to screen for which one of
the following frequently associated conditions? - -Pulmonary
arteriovenous malformations are found in 15%-30% of patients with
hereditary hemorrhagic telangiectasia (HHT), also known as Osler-
Weber-Rendu syndrome. All patients with possible or confirmed HHT
should be screened for pulmonary arteriovenous malformations with
contrast echocardiography (SOR C). While contrast echocardiography is
used to detect atrioseptal and ventricular septal defects, neither of
these conditions is particularly prevalent in HHT. Aortic aneurysms and
myocardial perfusion defects are also not associated with HHT.
-chronic back pain management - -Most chronic back pain (up to 70%)
is nonspecific or idiopathic in origin. Treatment options that have the
best evidence for effectiveness include analgesics (acetaminophen,
tramadol, NSAIDs), multidisciplinary rehabilitation, and acupuncture
-sensorineural hearing loss TX - -When a patient presents with sudden
hearing loss it is important to distinguish between sensorineural and
conductive hearing loss. Patients should be asked about previous
episodes, and the workup should include both an assessment for
bilateral hearing loss and a neurologic examination. Sudden
sensorineural hearing loss is diagnosed by audiometry demonstrating a
30-decibel hearing loss at three consecutive frequencies, with no other
cause indicated from the physical examination.
,Evaluation for retrocochlear pathology may include auditory brainstem
response, MRI, or follow-up audiometry. Routinely prescribing antiviral
agents, thrombolytics, vasodilators, vasoactive substances, or
antioxidants is not recommended. Oral corticosteroids may be offered
as initial therapy, and hyperbaric oxygen therapy may be helpful within
3 months of diagnosis. The guidelines also strongly recommend against
routine laboratory tests or CT of the head as part of the initial
evaluation.
oral corticosteroids
-treatment for painful subacute thyroiditis: - -prednisone
This patient has signs and symptoms of painful subacute thyroiditis,
including a painful thyroid gland, hyperthyroidism, and an elevated
erythrocyte sedimentation rate. It is unclear whether there is a viral
etiology to this self-limited disorder. Thyroid function returns to normal
in most patients after several weeks, and may be followed by a
temporary hypothyroid state. Treatment is symptomatic. Although
NSAIDs can be helpful for mild pain, high-dose glucocorticoids provide
quicker relief for the more severe symptoms.
Levothyroxine is not indicated in this hyperthyroid state. Neither
thyroidectomy nor antibiotics is indicated for this problem.
-how to treat COPD - -supplemental oxygen
This patient with moderate COPD and moderate nonpulmonary arterial
hypertension pulmonary hypertension is hypoxic and meets the criteria
for use of supplemental oxygen (SOR A). Sildenafil and nifedipine are
utilized in pulmonary arterial hypertension, but evidence is lacking for
their use in pulmonary hypertension associated with chronic lung
disease and/or hypoxemia. Low-dose prednisone may be a future
option.
-Clinical features may be quite variable, and the most useful predictive
factor in distinguishing uncomplicated pyelonephritis from perinephric
abscess is persistence of fever for more than 4 days after initiation of
antibiotic therapy. - -Perinephric abscess is an elusive diagnostic
problem that is defined as a collection of pus in the tissue surrounding
the kidney, generally in the space enclosed by Gerota's fascia. Mortality
rates as high as 50% have been reported, usually from failure to
diagnose the problem in a timely fashion. The difficulty in making the
diagnosis can be attributed to the variable constellation of symptoms
and the sometimes indolent course of this disease. The diagnosis should
be considered when a patient has fever and persistence of flank pain.
Do a CT
, -what pre op testing for cataracts? - -According to a recent Cochrane
review, routine preoperative testing prior to cataract surgery does not
decrease intraoperative or postoperative complications (SOR A). The
American Heart Association recommends against routine preoperative
testing in asymptomatic patients undergoing low-risk procedures, since
the cardiac risk associated with such procedures is less than 1%.
-asthma criteria - -The 2007 update to the guidelines for the diagnosis
and management of asthma published by the National Heart, Lung, and
Blood Institute outlines clear definitions of asthma severity. Severity is
determined by the most severe category in which any feature occurs.
This patient has mild persistent asthma, based on her symptoms
occurring more than 2 days per week, but not daily, and use of her
albuterol inhaler more than 2 days per week, but not daily. Clinicians
can use this assessment to help guide therapy
-diabetes criteria - -Current criteria for the diagnosis of diabetes
mellitus include a hemoglobin A1c≥6.5%, a fasting plasma glucose level
≥126 mg/dL, a 2-hour plasma glucose leve l≥200 mg/dL, or, in a
symptomatic patient, a random blood glucose level ³200 mg/dL. In the
absence of unequivocal hyperglycemia, results require confirmation by
repeat testing.
-perilymphatic fistula - -A perilymphatic fistula between the middle and
inner ear may be caused by barotrauma from scuba diving, as well as
by direct blows, heavy weight bearing, and excessive straining (e.g.,
with sneezing or bowel movements.) This patients recent trip involved
two of these potential factors. Vestibular neuronitis is a more sudden,
unremitting syndrome. Menieres disease is manifested by episodes of
vertigo, associated with hearing loss and often with nausea and
vomiting. Benign paroxysmal positional vertigo is more likely in older
individuals, and is associated with postural change. Multiple sclerosis
requires symptoms in multiple areas and is not thought to be provoked
by climate change.
-testing for septic arthritis - -This child meets the criteria for possible
septic arthritis. In this case ultrasonography is recommended over other
imaging procedures. It is highly sensitive for detecting effusion of the
hip joint. If an effusion is present, urgent ultrasound-guided aspiration
should be performed. Bone scintigraphy is excellent for evaluating a
limping child when the history, physical examination, and radiographic
and sonographic findings fail to localize the pathology. CT is indicated
when cortical bone must be visualized. MRI provides excellent
visualization of joints, soft tissues, cartilage, and medullary bone. It is
especially useful for confirming osteomyelitis, delineating the extent of
malignancies, identifying stress fractures, and diagnosing early Legg-
Calvé-Perthes disease. Plain film radiography is often obtained as an
initial imaging modality in any child with a limp. However, films may be
normal in patients with septic arthritis, providing a false-negative result.
Latest Update- 91 Questions
and 100% Correct Answers
A 52-year-old male has a skin lesion removed from his arm with
appropriate sterile precautions.
Which one of the following would be most appropriate to use on this
surgical wound? - -The American Academy of Dermatology recommends
against the routine use of topical antibiotics for clean
surgical wounds, based on randomized, controlled trials. Topical
antibiotics have not been shown to reduce
the rate of infection in clean surgical wounds compared to the use of
nonantibiotic ointment or no ointment.
Studies have shown that white petrolatum ointment is as effective as
antibiotic ointment in postprocedure
care.
use petrolatum
-A 23-year-old female presents with recurrent unprovoked epistaxis.
The patient's mother is known to have hereditary hemorrhagic
telangiectasia.
Contrast echocardiography is recommended to screen for which one of
the following frequently associated conditions? - -Pulmonary
arteriovenous malformations are found in 15%-30% of patients with
hereditary hemorrhagic telangiectasia (HHT), also known as Osler-
Weber-Rendu syndrome. All patients with possible or confirmed HHT
should be screened for pulmonary arteriovenous malformations with
contrast echocardiography (SOR C). While contrast echocardiography is
used to detect atrioseptal and ventricular septal defects, neither of
these conditions is particularly prevalent in HHT. Aortic aneurysms and
myocardial perfusion defects are also not associated with HHT.
-chronic back pain management - -Most chronic back pain (up to 70%)
is nonspecific or idiopathic in origin. Treatment options that have the
best evidence for effectiveness include analgesics (acetaminophen,
tramadol, NSAIDs), multidisciplinary rehabilitation, and acupuncture
-sensorineural hearing loss TX - -When a patient presents with sudden
hearing loss it is important to distinguish between sensorineural and
conductive hearing loss. Patients should be asked about previous
episodes, and the workup should include both an assessment for
bilateral hearing loss and a neurologic examination. Sudden
sensorineural hearing loss is diagnosed by audiometry demonstrating a
30-decibel hearing loss at three consecutive frequencies, with no other
cause indicated from the physical examination.
,Evaluation for retrocochlear pathology may include auditory brainstem
response, MRI, or follow-up audiometry. Routinely prescribing antiviral
agents, thrombolytics, vasodilators, vasoactive substances, or
antioxidants is not recommended. Oral corticosteroids may be offered
as initial therapy, and hyperbaric oxygen therapy may be helpful within
3 months of diagnosis. The guidelines also strongly recommend against
routine laboratory tests or CT of the head as part of the initial
evaluation.
oral corticosteroids
-treatment for painful subacute thyroiditis: - -prednisone
This patient has signs and symptoms of painful subacute thyroiditis,
including a painful thyroid gland, hyperthyroidism, and an elevated
erythrocyte sedimentation rate. It is unclear whether there is a viral
etiology to this self-limited disorder. Thyroid function returns to normal
in most patients after several weeks, and may be followed by a
temporary hypothyroid state. Treatment is symptomatic. Although
NSAIDs can be helpful for mild pain, high-dose glucocorticoids provide
quicker relief for the more severe symptoms.
Levothyroxine is not indicated in this hyperthyroid state. Neither
thyroidectomy nor antibiotics is indicated for this problem.
-how to treat COPD - -supplemental oxygen
This patient with moderate COPD and moderate nonpulmonary arterial
hypertension pulmonary hypertension is hypoxic and meets the criteria
for use of supplemental oxygen (SOR A). Sildenafil and nifedipine are
utilized in pulmonary arterial hypertension, but evidence is lacking for
their use in pulmonary hypertension associated with chronic lung
disease and/or hypoxemia. Low-dose prednisone may be a future
option.
-Clinical features may be quite variable, and the most useful predictive
factor in distinguishing uncomplicated pyelonephritis from perinephric
abscess is persistence of fever for more than 4 days after initiation of
antibiotic therapy. - -Perinephric abscess is an elusive diagnostic
problem that is defined as a collection of pus in the tissue surrounding
the kidney, generally in the space enclosed by Gerota's fascia. Mortality
rates as high as 50% have been reported, usually from failure to
diagnose the problem in a timely fashion. The difficulty in making the
diagnosis can be attributed to the variable constellation of symptoms
and the sometimes indolent course of this disease. The diagnosis should
be considered when a patient has fever and persistence of flank pain.
Do a CT
, -what pre op testing for cataracts? - -According to a recent Cochrane
review, routine preoperative testing prior to cataract surgery does not
decrease intraoperative or postoperative complications (SOR A). The
American Heart Association recommends against routine preoperative
testing in asymptomatic patients undergoing low-risk procedures, since
the cardiac risk associated with such procedures is less than 1%.
-asthma criteria - -The 2007 update to the guidelines for the diagnosis
and management of asthma published by the National Heart, Lung, and
Blood Institute outlines clear definitions of asthma severity. Severity is
determined by the most severe category in which any feature occurs.
This patient has mild persistent asthma, based on her symptoms
occurring more than 2 days per week, but not daily, and use of her
albuterol inhaler more than 2 days per week, but not daily. Clinicians
can use this assessment to help guide therapy
-diabetes criteria - -Current criteria for the diagnosis of diabetes
mellitus include a hemoglobin A1c≥6.5%, a fasting plasma glucose level
≥126 mg/dL, a 2-hour plasma glucose leve l≥200 mg/dL, or, in a
symptomatic patient, a random blood glucose level ³200 mg/dL. In the
absence of unequivocal hyperglycemia, results require confirmation by
repeat testing.
-perilymphatic fistula - -A perilymphatic fistula between the middle and
inner ear may be caused by barotrauma from scuba diving, as well as
by direct blows, heavy weight bearing, and excessive straining (e.g.,
with sneezing or bowel movements.) This patients recent trip involved
two of these potential factors. Vestibular neuronitis is a more sudden,
unremitting syndrome. Menieres disease is manifested by episodes of
vertigo, associated with hearing loss and often with nausea and
vomiting. Benign paroxysmal positional vertigo is more likely in older
individuals, and is associated with postural change. Multiple sclerosis
requires symptoms in multiple areas and is not thought to be provoked
by climate change.
-testing for septic arthritis - -This child meets the criteria for possible
septic arthritis. In this case ultrasonography is recommended over other
imaging procedures. It is highly sensitive for detecting effusion of the
hip joint. If an effusion is present, urgent ultrasound-guided aspiration
should be performed. Bone scintigraphy is excellent for evaluating a
limping child when the history, physical examination, and radiographic
and sonographic findings fail to localize the pathology. CT is indicated
when cortical bone must be visualized. MRI provides excellent
visualization of joints, soft tissues, cartilage, and medullary bone. It is
especially useful for confirming osteomyelitis, delineating the extent of
malignancies, identifying stress fractures, and diagnosing early Legg-
Calvé-Perthes disease. Plain film radiography is often obtained as an
initial imaging modality in any child with a limp. However, films may be
normal in patients with septic arthritis, providing a false-negative result.
