Myocardial ischemia in older patients

Which of the following symptoms is more likely to represent myocardial ischemia in older patients?

• A) Chest pain
• B) Dyspnea
• C) Diaphoresis
• D) Back pain
• E) Jaw pain

Answer and Discussion

The answer is B.
Exertional angina (chest pain) is the most common manifestation of myocardial ischemia in young and middle-age persons. Because of their more sedentary lifestyle or possibly a difference in pathophysiology, this may not be true in elderly patients. Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients. Other elderly patients with CAD may be completely asymptomatic, although silent ischemia may be demonstrated by stress testing or Holter monitoring.

Note:

Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients.

Family Practice Examination & Board Review

Family Practice Examination & Board Review, Second Edition (McGraw-Hill Specialty Board Review)

A Comprehensive Case-Based Review Guide for the Family Practice Boards or Recertification Exam
5 STAR DOODY’S REVIEW!

“The book is both broad and comprehensive, with chapters written by family physicians and specialists who contribute informative, easy to follow, and concise discussions. Chapters cover the main systems of the body as well as HIV/AIDS, men’s health, women’s health, care of the surgical patient, and care of the older patient. In addition, there are chapters not traditionally included in board review books on ethics, end-of-life care, evidence-based medicine, and patient-centered care. Chapters are well written, contain questions consistent with those found on the boards, and provide explanations that will help readers navigate these topics on the exam. The case-based approach provides a comprehensive review of topics commonly encountered in the family physician’s office. Each chapter contains clinical pearls, quizzes, and objectives to ensure that the main points have been addressed. The numerous illustrations include quality images of dermatological conditions, EKGs, and x-rays. Tables provide useful charts and are effective teaching tools.

This will be a wonderful resource not only for those preparing for the family medicine boards, but also for family medicine residents, physicians, and anyone else working in a primary care setting.” — Doody’s

Family Practice Examination & Board Review serves as an ideal study guide for the primary and recertification exam in family medicine and for licensure exams. Containing more than 400 progressive clinical cases that cover all specialty and topic areas tested on the exams, this uniqueguide features a step-by-step approach that ensures you fully comprehend a subject before moving on to a more advanced one.
Features:
* More than 400 case studies that reflect the realities of clinical practice

* Comprehensive coverage of ALL topics on the boards and recertifying exam

* Hundreds of “Helpful Tip” boxes that provide valuable clinical pearls

* Learning aids including “Quick Quizzes,” learning objectives, and online resources

* Up-to-date coverage of evolving issues such as multicultural medicine and evidence-based medicine

* High-quality color photographs of conditions most easily diagnosed by appearance

* More color photos and diagrams than in the previous edition

* Improved design — so you can spend more time learning and less time looking for answers

* Completely updated content reflecting all major new developments in diagnosis and treatment

* NEW! Expanded coverage of current topics such as clinical ethics, women’s health, and obstetrics

About head lice infestations

Which of the following statements is true regarding head lice infestations?

• A) Females are more likely affected.
• B) Retreatment with pyrethrin is rarely needed.
• C) Head lice can live off the body up to 1 week.
• D) Low socioeconomic children are more likely affected.
• E) Dogs are a common vector for head lice.

The answer is:  ( A ).

Head lice are thought to be the most common type and are developing resistance to commonly used pediculicides. Every year, between 6 million and 12 million people in the United States, primarily children 3 to 10 years of age, are infested with head lice. Girls are at greater risk  because...........

Read more...........>>

Suturing Workshop

A discussion and demonstration of suturing techniques with Lee Dresang, MD from the University of Wisconsin Department of Family Medicine.

About Cognitive therapy

Cognitive therapy involves :

• A) repetition of negative thoughts that eventually dissipate
• B) changing a thought that involves a situation that leads to a change of mood, behavior, or reaction
• C) repeated acts of fearful situations that allow adaptation
• D) negative reinforcement of harmful activities
• E) none of the above

The answer is  : (B).

 
Cognitive therapy is a psychological treatment method that helps patients correct false self-beliefs that contribute to certain moods and behaviors. The basic principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person's environment, physical reaction, and subsequent behavior.
Therefore, changing a thought that arises in a given situation changes mood, behavior, and physical reaction. Although it is unclear who benefits most from cognitive therapy, motivated patients who have an internal center of control and the capacity for introspection likely would benefit most.

Facts about Insomnia

Primary insomnia is usually associated with

• A) sleep apnea
• B) restless legs syndrome
• C) periodic limb movements
• D) circadian rhythm sleep disorders
• E) none of the above

Answer and Discussion
Insomnia is defined as inadequate or poor-quality sleep characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning, or sleep that is not refreshing. Insomnia also involves daytime consequences such as fatigue, difficulty concentrating, and irritability.

Periods of insomnia lasting between 1 night and a few weeks are defined as acute insomnia. Chronic insomnia refers to sleep difficulty occurring at least 3 nights per week for 1 month or more.

Insomnia may be associated with specific sleep disorders, including restless legs syndrome, periodic limb movement disorder, sleep apnea, and circadian rhythm sleep disorders. Restless legs syndrome is characterized by unpleasant sensations in the legs or feet that are temporarily relieved by movement. Symptoms are worse in the evening, especially when a person is lying down and remaining still. The sensations cause difficulty falling asleep and are often accompanied by periodic limb movements. Periodic limb movement disorder is characterized by bilateral repeated and rhythmic, small-amplitude jerking or twitching movements in the lower extremities and, less frequently, in the arms. These movements occur every 20 to 90 seconds and can lead to awakenings, which are usually not noticed by the patient. Often the patient reports that sleep is not refreshing. In many cases, the bed partner is more likely to report the movement problem. Obstructive sleep apnea is most commonly associated with snoring, daytime sleepiness and obesity but occasionally presents with insomnia. Circadian rhythm sleep disorders including sleep-work insomnia are characterized by an inability to sleep because of a disturbance between the circadian sleep rhythm and the desired or required sleep schedule.

Primary insomnia occurs in the absence of the previously mentioned conditions . When the insomnia persists beyond 1 or 2 nights or becomes predictable, treatment should be considered. Pharmacologic treatment is usually effective, especially short-acting hypnotics.
Sleep hygiene measures may also be useful. Chronic insomnia may be more difficult to treat. Because chronic insomnia is often multifactorial in etiology, a patient may need multiple treatment modalities, including medication (antidepressants, antihistamines, melatonin) and behavioral therapy. If an underlying medical or psychiatric condition is identified, this condition should be treated first. The answer is E.

Dealing with Primary Dysmenorrhea

Which of the following is considered first-line therapy for primary dysmenorrhea?
A) Nonsteroidal anti-inflammatories (NSAIDs)
B) Selective serotonin receptor inhibitors (SSRIs)
C) Antiestrogens
D) Acupuncture
E) Tricyclic antidepressants





Answer and Discussion
Primary dysmenorrhea is associated with cramping pain in the lower abdomen occurring just before and/or during menstruation, in the absence of other conditions such as endometriosis. The initial presentation of primary dysmenorrhea typically occurs in adolescence.
The condition is associated with increased production of endometrial prostaglandin, resulting in increased uterine tone and stronger, more frequent uterine contractions. A diagnostic evaluation is unnecessary in women with typical symptoms and in the absence of risk factors for secondary causes.

NSAIDs are the most effective treatment, with the addition of oral contraceptive pills when necessary. About 10% of affected women do not respond to these measures. In these cases it is important to consider secondary causes of dysmenorrhea in women affected. Acupuncture is also used as an alternative treatment.The answer is A.

Bratton's Family Medicine Board Review

"Bratton's Family Medicine Board Review"

Bratton's Family Medicine Board Review
ISBN: 0781772877 | edition 2007 | CHM | 432 pages | 19,9 mb

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