Family Medicine Written Board Exam Sample Questions
Book 2 - 2005
Close Window.

QUESTION

90. All of the following regarding over-the-counter medications during pregnancy are correct EXCEPT:

A) Acetaminophen (Tylenol) is the medication of choice for pain and fever relief during all trimesters of pregnancy
B) For relief of cold symptoms, dextromethorphan hydrobromide (Benylin DM) appears to be safe at recommended dosages, but pseudoephedrine hydrochloride (Novafed) and guaifenesin (Humibid LA) should be avoided during the 1st trimester
C) Aspirin can be taken safely during the 1st and 2nd trimester, but not the 3rd
D) The safety of nicotine replacement products in pregnancy is unknown, but smoking is likely to be more harmful than nicotine replacement
E) Kaolin and pectin (Kaopectate) are not absorbed and are therefore considered safe during pregnancy for treatment of diarrhea

ANSWER

90.     C     Aspirin can be taken safely during the 1st and 2nd trimester, but not
the 3rd

It is estimated that more than 80 percent of pregnant women take over-the-counter or prescription drugs during pregnancy. For pain and fever relief, acetaminophen is the drug of choice. There is no known association with teratogenicity. This is through its extensive use in pregnancy and the paucity of documented adverse effects. The Collaborative Perinatal Project found sufficient evidence indicating a lack of adverse effects of dextromethorphan use during pregnancy. Pseudoephedrine may be associated with gastroschisis and guaifenesin, in the presence of a febrile illness may be associated with an increased risk of neural tube defects. Therefore both should be avoided during the 1st trimester. Salicylates, such as aspirin, have been associated with increased perinatal mortality, neonatal hemorrhage, decreased birth weight, prolonged gestation and labor, and possible birth defects. Cigarette smoke contains more than 3,000 different chemicals potentially harmful to humans, and one of the main components of cigarette smoke is carbon monoxide, a known fetal toxin. Therefore, in patients who cannot maintain smoking abstinence without pharmacologic intervention, intermediate-release nicotine preparations (nicotine gum, nicotine spray and nicotine inhaler) may be considered. If treatment of diarrhea is needed, kaolin and pectin (Kaopectate) is considered safe during pregnancy as it is not absorbed.

1. Black RA, Hill, DA. Over-the-Counter Medications in Pregnancy, Am Fam Physician. June 15, 2003:67(12):2517-2524.

142. A 36-year-old male presents with palpitations. He admits to chest discomfort, weakness, and anxiety. His pulse is 150 beats per minute, and his blood pressure is 100/70 mmHg. Heart sounds are normal. Pressure on the carotid sinus changes the heart rate to 75 beats per minute, but when released the pulse rate returns to 150 beats per minute.

The MOST likely diagnosis is:

A) atrial flutter with 2:1 block
B) paroxysmal atrial tachycardia with 2:1 block
C) sinus arrhythmia
D) atrial fibrillation
E) nodal tachycardia

ANSWER

142.     A     Atrial flutter with 2:1 block

The signs and symptoms are like any other sudden paroxysmal tachycardia, but the ventricular rate is the clue. After applying carotid pressure, a diagnosis of atrial flutter with 2:1 block is suggested, as the sudden change to half rate on vagal stimulation occurs. The maneuver is useful for diagnosis but not for converting atrial flutter to a sinus rhythm. Often very low amounts of energy (25-50 joules), during cardioversion will convert atrial flutter. At times catheter ablation of the flutter pathway is required in chronic atrial flutter. Additionally, the chronic form of this arrhythmia can be managed with rate control by using by digoxin, beta blockers, or calcium channel blockers. The most common causes of atrial flutter are congenital heart disease, mitral valve disorders, and cardiomyopathy.

1. Fuster V, Alexander RW, O’Rourke RA, et al: The Heart, 10th ed. McGraw-Hill, New York NY. 2001:820-823.

150. A 42-year-old male has a history of low back pain and stiffness as well as multiple episodes of unilateral uveitis. After several months of mild symptoms he notes more severe stiffness at night and hip pain.

On physical examination there is paravertebral muscle tenderness and limited flexion of the lumbar spine. A diastolic murmur is also noted.

The MOST likely diagnosis is:

A) Pseudogout
B) Ankylosing spondylitis
C) Rheumatoid arthritis
D) Marfan syndrome
E) Psoas abscess

ANSWER

150.     B     Ankylosing spondylitis

Ankylosing spondylitis occurs in 1-6% of adults inheriting HLA-B27. However, the prevalence in B27-positive relatives of patients with ankylosing spondylitis is up to 30%. Men are up to 3 times more likely to be affected. The frequency of aortic insufficiency in patients with ankylosing spondylitis is about 4%. Other cardiac valve abnormalities are not increased in incidence. Acute anterior uveitis is the most common extra-articular manifestation. Attacks are unilateral and tend to recur, often in the other eye.

Marfan syndrome inheritance is autosomal dominant. The associated aortic lesion is a cystic medial necrosis with loss of elastic tissue, resulting in aneurysm formation. Mitral valve prolapse can also be part of the syndrome. Dislocation of the lens is the most apparent eye abnormality. A psoas abscess may cause fever, and would not have any cardiac manifestations.

1. Braunwald E, Fauci A, et al: Harrison’s Principles of Internal Medicine, 15th ed. McGaw-Hill, New York NY. 2001:1949-1950.

Close Window.