Family Medicine 1

Family Medicine 1

By Megan Persenaire

Multiple Choice

Which of the following best describes the mechanism of action of the typical first line treatment for hyperlipidemia?

• Prevention of synthesis of mevalonate, a cholesterol precursor, via inhibition of the enzyme hydroxymethylglutaryl-CoA reductase, the first and rate limiting step in hepatic cholesterol synthesis.

• Inhibition of sterol transporter at small intestine brush border, preventing the absorption of cholesterol.

• Binding of bile acids in the intestine, blocking enterohepatic reabsorption of bile acids and increasing fecal bile acid secretion.

• Antibodies bind to free proprotein convertase subtilisin/kexin type 9, thereby interfering with its binding to the LDL receptor, leading to reduced degradation of the LDL receptor and increased liver clearance of LDL.

Multiple Choice

You are evaluating a 72 y/o male for an annual physical. He recently completed an echocardiogram given his history of poorly controlled hypertension. The echocardiogram revealed mild chronic heart failure with preserved ejection fraction. He is currently asymptomatic. Which of the following would not be a recommendation for this patient?

• Daily weight monitoring

• Sodium restriction

• Fluid restriction

• Alcohol cessation

Open Ended

What am I?

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Multiple Choice

You are evaluating a 52 y/o female for an annual physical examination. During your examination you notice a thyroid nodule. You pursue an ultrasound and then a biopsy. The biopsy shows nests of round or ovoid cells and spindle-shaped cells without follicle development along with amyloid deposits. The calcitonin level is also elevated. Which of the following is the most likely diagnosis?

• Anaplastic thyroid carcinoma

• Papillary thyroid carcinoma

• Follicular thyroid carcinoma

• Medullary thyroid carcinoma

Multiple Choice

A 15 y/o boy with a history of asthma presents to your office for 2 weeks of a cough. It initially was nonproductive but over the last week he has developed more mucous. He initially noticed a runny nose, sore throat, and headache but these resolved after the first week. He has not had a fever. He does endorse occasional wheezing while coughing and this does temporarily improve with use of albuterol. On auscultation of the lungs, he does have some rhonchi at the bases but these clear after he coughed. Physical examination and vitals are otherwise normal. Which of the following is the most appropriate next step?

• Chest x-ray

• Supportive management

• Provide an in-office nebulizer treatment

• Initiate oral antibiotics

Multiple Choice

What is the most common long-term complication of this type of injury?

• Post-traumatic arthritis

• Avascular necrosis

• Neuropathy

• Bone spur development