Multiple-choice questions for general practitioner (GP) Doctor

Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low-dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.

References:
http://www.aafp.org/afp/2005/0201/p469.html

Hydrochlorothiazide Approximately 95% of a single dose of lithium is eliminated in the urine. The drug is handled by the kidneys in the same manner as sodium, ie most of the filtered lithium is reabsorbed in the proximal tubule. Hence loading with sodium will increase lithium excretion, while sodium depletion will promote the retention of lithium. All diuretics decrease renal lithium clearance. However, thiazide diuretics cause the greatest retention of lithium amongst all diuretics.

The correct answer is B. This patient, with a long history of chronic obstructive pulmonary disease (COPD), has evidence of a community-acquired pneumonia. The common organisms causing pneumonias in patients with COPD are Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis

Congenital adrenal hyperplasia autosomal recessive disorder characterized by the partial or total defect of various synthetic enzyme of the adrenal cortex required for cortisol and aldosterone production Clinical Presentation - Classic presentation: vomiting, dehydration, Hyperkalemia, Hyponatremia, hypoglycemia, and fem has Ambiguous genitalia at birth.

Antitetanus vaccination in multiple doses (2?) is up to 98% effective in preventing neonatal tetanus and neonatal tetanus deaths in under-resourced settings. Single doses of the tetanus vaccine are not enough to prevent neonatal tetanus deaths. In addition to administration of antitetanus vaccines, efforts should be made to ensure that women receive obstetric care to ensure clean deliveries.

A person with expressive aphasia will exhibit halting and effortful speech. Speech m important content words. Word comprehension is preserved. The person may still be understood, but sentence grammatical.
This contrasts with receptive or Wernicke's aphasia, which is distinguished by a patient's inability comprehend language or speak with appropriately meaningful words though fluency, may be preserved.

A bruit and pulsatile abdominal mass are hallmark signs of an abdominal aortic aneurysm (AAA). The fact that the medical student was palpating the area and the patient passed out was a coincidence; however,

syncope in the setting of the AAA is rupture until proven otherwise. Ruptured peptic ulcer would have more severe and sharp abdominal pain. Hemorrhagic gastritis could cause syncope, but the bleeding would cause emesis, and the patient is supine, so orthostasis is not of concern. Narcolepsy would not have hypotension. This patient's abdominal pain was from the AAA beginning to rupture and was dull and gradual in onset.

Synchronized cardioversion is used when ventricular tachycardia is associated with acute pulmonary edema. Unsynchronized cardioversion is used for ventricular fibrillation or ventricular tachycardia without a pulse. Medical therapy, such as lidocaine, amiodarone, or procainamide, can be used for sustained ventricular tachycardia that is hemodynamically stable.