USMLE Forum Archives - USMLE Step 2 CK - IM 11
IM 11
TheOne - 11-06-06 12:52
A 45-year-old man comes to the physician for his annual physical examination. He was last seen 3 years ago for a periodic health examination and was in good health. He is on no medications. His past medical history is significant for a appendectomy 5 years ago and rheumatic fever at age 12. He has been smoking approximately half a pack of cigarettes daily for the past 20 years. On physical examination, his blood pressure is 148/56 mm Hg, pulse is 78/min, and respirations are 16/min. He is afebrile. A head and neck examination is normal. His lungs are clear. He has a regular heart rhythm, with a II/VI blowing decrescendo diastolic murmur heard at the aortic area. His abdominal and rectal examinations are normal. CBC, electrolytes, and thyroid function tests are normal. Which of the following is the most appropriate advice for this man regarding future preventive health maintenance?
A. Antibiotic prophylaxis before dental work
B. Annual chest x-ray film
C. Annual echocardiogram
D. Annual flexible sigmoidoscopy
E. Annual prostate specific antigen testing
TheOne - 11-06-06 12:52
A 45-year-old man comes to the physician for his annual physical examination. He was last seen 3 years ago for a periodic health examination and was in good health. He is on no medications. His past medical history is significant for a appendectomy 5 years ago and rheumatic fever at age 12. He has been smoking approximately half a pack of cigarettes daily for the past 20 years. On physical examination, his blood pressure is 148/56 mm Hg, pulse is 78/min, and respirations are 16/min. He is afebrile. A head and neck examination is normal. His lungs are clear. He has a regular heart rhythm, with a II/VI blowing decrescendo diastolic murmur heard at the aortic area. His abdominal and rectal examinations are normal. CBC, electrolytes, and thyroid function tests are normal. Which of the following is the most appropriate advice for this man regarding future preventive health maintenance?
A. Antibiotic prophylaxis before dental work
B. Annual chest x-ray film
C. Annual echocardiogram
D. Annual flexible sigmoidoscopy
E. Annual prostate specific antigen testing
Page 1
#1
Re: IM 11 kingkong - 11-06-06 20:49 (A) appears to be a reasonable answer since he has a h/o rheumatic fever + has aortic insufficiency.
#2
Re: IM 11
TheOne - 11-09-06 12:57 Explanation: The correct answer is A. This patient should have antibiotic prophylaxis before undergoing dental work. The patient's physical examination is consistent with asymptomatic aortic insufficiency, as indicated by his lack of symptoms combined with a characteristic diastolic murmur. This has occurred as a result of his childhood rheumatic fever. Patients with any significant cardiac valvular disease should be instructed to have antibiotic prophylaxis before dental work to reduce the risk of subacute bacterial
endocarditis.
Although this man is at increased risk for lung cancer given his long history of smoking, chest x-ray films (choice B) have never been proven effective as early detection. Although he does have underlying valvular heart disease, there is no indication for an annual echocardiogram (choice C) unless specific symptoms develop and warrant evaluation.
A sigmoidoscopy (choice D) is one of several choices that are appropriate colorectal cancer screening examinations beginning at age 50. Prostate specific antigen testing (choice E) remains controversial in asymptomatic adults and is certainly not recommended in asymptomatic men younger than 50.
Page 1