SHELF / USMLE step 2 Practice Questions - Family Medicine
SHELF / USMLE Step 2 Practice Questions > Family Medicine
Q1) A 77 year old man is found to have asymptomatic atrial fibrillation on routine examination. His past medical history is significant for hypertension, diabetes, and osteoarthritis. His medications are atenolol and simvastatin. On exam his weight is 72kg, bp is 138/76 and his resting HR is 78 bpm. His JVP is
a) initiation of warfarin therapy, 5mg / day
b) referral for cardioversion and mantenance with low-dose amiodarone therapy
c) initiation of aspirin therapy 325mg / day
d) initiation of low molecular weight heparin with warfarin for 3 days followed by warfarin therapy alone, 5mg / day
e) continue to monitor the patient every 6 month and initiate treatment if he becomes symptomatic
Q2) A 65-year-old previously healthy woman reports difficulty swallowing over the past 2 months. The difficulty occurs several seconds after attempting to swallow the food with the feeling that the food is getting stuck at the suprasternal notch. She does not have any symptoms of heart burn, has not lost weight and has a normal physical exam. What is the next step in managing this patients symptoms?
a) barium swallow
b) upper endoscopy
c) esophageal manometry
d) surgical myotomy
e) calcium channel blocker
Q3) A 63 year-old non-smoker comes to your office with a 3 day history of a cough productive of yellow sputum. He has a fever of 101.3 and 'wheezy.' Which of the following tests is most appropriate at this time?
a) CT scan of the chest
b) spirometry
c) chest x-ray
d) sputum culture
e) place a PPD
A1) a - initiation of warfarin therapy, 5mg / day
A2) b - upper endoscopy
A3) c- chest x-ray
Recommended family medicine text: Essentials of Family Medicine (Sloane)
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3 comments:
For dysphagia, you need a barium swallow before an endoscopy. This helps limit the possibility of perforation if there is minimal lumen left.
Question 1: Simply starting a patient on Warfarin provides no immediate anticoagulation therapy as Warfarin requires several days to take effect. Patients are typically bridged over on Heparin til an INR shows patient within therapeutic range. Only at that time is solo therpay with Warfarin acceptable
Re: the dysphagia question--yes, barium first, then endoscopy.
Re: AFib -- those guidelines recently changed; you do NOT need to bridge them over with heparin. But lots of clinicians are having trouble switching to the new recommendations having used the heparin bridge for so long.
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