July 2012 - Gim

12 Questions | Total Attempts: 66

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University Quizzes & Trivia

Questions and Answers
  • 1. 
    A 46-year-old woman is evaluated for a 2-year history of fatigue and not feeling rested despite sleeping 9 to 10 hours per night. Before this period, she ran 2 to 3 miles daily. Now, she tries to walk 1 to 2 miles two or three times per week but feels much too tired to run. After walking, she feels extremely fatigued, and her joints and muscles ache. Her appetite is about the same, and she has gained a few pounds, with a current BMI of 27. She denies difficulty getting to sleep or staying asleep, and her husband has not noticed any snoring or apnea. She denies depressed mood or anhedonia. Her physical examination is unremarkable. Complete blood count, erythrocyte sedimentation rate, serum chemistry studies, and thyroid-stimulating hormone level are normal. Which of the following is the most effective treatment for this patient at this time
    • A. 

      Acclydine

    • B. 

      Acyclovir

    • C. 

      Cognitive-behavioral therapy

    • D. 

      Fluoxetine

  • 2. 
    A 75-year-old man is admitted to a nursing home after having a stroke 2 weeks ago. The patient has residual right-sided paralysis, aphasia and urinary incontinence. He can respond to verbal commands but cannot speak well enough to make his needs known. His ability to walk is greatly impaired, and he spends most of the day in bed or in a chair. He is unable to change position independently and needs assistance with all activities of daily living. The patient has a poor appetite, cannot use his right arm to feed himself, and is eating only half his meals. He also has intermittent urinary incontinence. Which of the following is the most appropriate intervention for preventing pressure ulcers in this patient?
    • A. 

      An air-fluidized bed

    • B. 

      A doughnut cushion when seated

    • C. 

      A foam mattress overlay

    • D. 

      Bladder catheterization

    • E. 

      Massage of skin over pressure points

  • 3. 
    A 45-year-old woman is evaluated because of the gradual onset of right-sided hearing loss and a 3-year history of tinnitus. She does not have ear pain or drainage, dizziness, or headache. There is no history of trauma to the ear or excessive exposure to loud noises. On examination, the patient is unable to hear numbers whispered 2 feet from the right ear with the left auditory canal blocked. Examination of the external auditory canals and tympanic membranes is normal. Neurologic examination is normal. When a tuning fork is placed on the top of her head, she reports that the sound is heard toward the left ear (Weber test). Results of audiometry show normal hearing on the left and 45-decibel high-frequency hearing loss on the right. Which of the following is the most likely diagnosis?
    • A. 

      Acoustic neuroma

    • B. 

      Cholesteatoma

    • C. 

      Meniere disease

    • D. 

      Otosclerosis

    • E. 

      Presbycusis

  • 4. 
    An 84-year-old man is evaluated for a 6-month history of slow urinary stream, urinary hesitancy, postvoid dribbling, and a need to get up an average of three times each night to urinate. He has chronic obstructive pulmonary disease and is on inhaled albuterol as needed and 2 L/min of home oxygen. On physical examination, temperature is normal, blood pressure is 140/76 mm Hg, and pulse rate is 76/min. Abdominal examination is normal without tenderness or masses or evidence of a distended bladder. Digital rectal examination reveals a symmetrically enlarged prostate without any discrete nodules or tenderness. Which of the following is the most useful test for evaluating this patient’s urinary symptoms?
    • A. 

      Postvoid residual urine volume measurement

    • B. 

      Prostate-specific antigen

    • C. 

      Prostate ultrasound

    • D. 

      Serum creatinine

    • E. 

      Urinalysis

  • 5. 
    A 34-year-old man is evaluated at the urging of his wife because of a 3-month history of nightmares, increased irritability, outbursts of anger, and social isolation. He recently returned from reserve duty in Iraq. The nightmares are especially frequent and troubling around the time of his monthly weekend reserve duty, and he has started to drink heavily at these times to try to block out the dreams. The patient has lost interest in his usual activities, does not play with his children, spends much time alone, won’t watch the news on television, and is very uncomfortable in crowded places, such as restaurants. He has avoided repeated efforts by his wife to talk about his experiences in Iraq. Findings on physical examination are unremarkable. Which of the following is the most effective treatment for this patient?
    • A. 

      Prescribe fluoxetine

    • B. 

      Prescribe zolpidem and alcohol counseling

    • C. 

      Provide brief counseling for the patient and his wife

    • D. 

      Refer for cognitive-behavioral therapy

    • E. 

      Refer for psychodynamic therapy

  • 6. 
    A 70-year-old man with severe disability due to claudication in his right leg and a 2-month history of increasingly frequent chest pain undergoes preoperative cardiovascular evaluation prior to elective right femoropopliteal bypass graft surgery. The patient can only walk one block because of claudication and chest pain despite adequate medical treatment. Medical history is significant for coronary artery disease, a myocardial infarction 4 years ago, hypertension, and type 2 diabetes mellitus. The patient underwent left femoropopliteal bypass graft surgery 2 years ago under general anesthesia without complications. He has a 55 pack-year smoking history but stopped smoking 2 years ago. Current medications are metoprolol, atorvastatin, amlodipine, fosinopril, isosorbide mononitrate, insulin glargine, insulin aspart, and aspirin. Vital signs are normal. There is no jugular venous distention. Cardiopulmonary examination is normal. Pulses in the right calf are decreased. There is no calf tenderness and no peripheral edema. An electrocardiogram shows Q waves in the inferior leads. Which of the following is the best preoperative management?
    • A. 

      Coronary angiography

    • B. 

      Dipyridamole nuclear imaging stress testing

    • C. 

      Dobutamine stress echocardiography

    • D. 

      Two-dimensional echocardiography

    • E. 

      No testing needed

  • 7. 
    A 64-year-old woman is evaluated during a health maintenance examination. She has hypertension and hypercholesterolemia. She has no symptoms to report. She is a current smoker, with a 20 pack-year history. Current medications are atenolol and hydrochlorothiazide. Vital signs are normal. BMI is 28. Funduscopic examination reveals bright, yellow, refractile deposits scattered in the retina of the right eye, with approximately five deposits seen on direct ophthalmoscopy. The left fundus appears normal. On visual acuity testing, near vision is 20/20 with reading glasses, and distance vision is 20/25 for both eyes. The remainder of the physical examination is normal. A lipid panel obtained prior to today’s visit reveals a total cholesterol of 190 mg/dL (4.92 mmol/L); LDL cholesterol of 120 mg/dL (3.11 mmol/L); HDL cholesterol of 40 mg/dL (1.04 mmol/L); and triglycerides of 150 mg/dL (1.70 mmol/L). Which of the following is the most effective management option for this patient’s ocular findings?
    • A. 

      Antioxidant supplements

    • B. 

      Atorvastatin

    • C. 

      Lower blood pressure to below 130/85 mm Hg

    • D. 

      Smoking cessation

  • 8. 
    .A 78-year-old woman is evaluated because of concerns about her ability to drive. She has trouble seeing on bright, sunny days and also at night because of the glare from headlights of oncoming cars. The patient has type 2 diabetes mellitus and a 55-pack-year smoking history. Her current medications include metformin and glipizide. This patient’s history is most suggestive of which of the following ophthalmologic disorders?
    • A. 

      Age-related macular degeneration

    • B. 

      Cataracts

    • C. 

      Presbyopia

    • D. 

      Primary open-angle glaucoma

    • E. 

      Proliferative diabetic retinopathy

  • 9. 
    A 21-year-old female college student is referred by the student health center for evaluation of a possible eating disorder. The patient acknowledges that she sometimes eats very large amounts of food and is unable to stop herself until she has consumed an entire container of ice cream or a bag of potato chips. She says that this eating behavior occurs almost daily while preparing for final examinations but may only occur once or twice weekly during less stressful times. She has never induced vomiting but does take laxatives and exercises for hours after one of these eating episodes. She also feels that her hips are too wide. Her older sister has required hospitalization several times for anorexia nervosa. Findings on physical examination are unremarkable. BMI is 22. Which of the following is the most likely diagnosis?
    • A. 

      Anorexia nervosa, binge-eating/purging type

    • B. 

      Anorexia nervosa, restricting type

    • C. 

      Binge-eating disorder

    • D. 

      Bulimia nervosa

  • 10. 
    A 54-year-old woman is evaluated for pain in the right posterior hip and pelvic area that she noticed upon awakening 3 days ago. She had been moving and lifting boxes the day before the onset of pain. She has experienced similar pain several times over the last 2 years, but it has never lasted so long. On physical examination, BMI is 30. The FABER test (Flexion, ABduction, and External Rotation of the hip) elicits pain in the right posterior pelvis. There is tenderness on palpation over the right posterior pelvic girdle. Flexing the hip is painful. There is no tenderness in the right groin, the right trochanter, or the right gluteal notch. Passive range of motion of the right hip reveals no pain. Straight-leg-raising test is negative, and deep tendon reflexes are normal. Which of the following is the most likely diagnosis?
    • A. 

      Osteoarthritis of the right hip

    • B. 

      Piriformis syndrome

    • C. 

      Right L5 radiculitis

    • D. 

      Right sacroiliitis

    • E. 

      Right trochanteric bursitis

  • 11. 
    A 64-year-old man is evaluated at a follow-up appointment. He had a left inguinal hernia diagnosed 6 months ago and has since had mild intermittent pain that is tolerable and does not interfere with his daily activities. He has not had previous hernia surgery, and he has had no episodes of bowel obstruction. The patient is reluctant to have surgery. He had a myocardial infarction 9 months ago, but has had no chest pain or other cardiopulmonary symptoms since then. Current medications are tamsulosin, aspirin, metoprolol, pravastatin, and lisinopril. On physical examination, the prostate is enlarged, and there is a left inguinal hernia that arises above the inguinal ligament and moves toward the scrotum with the Valsalva maneuver. Which of the following is the most appropriate management option for this patient?
    • A. 

      Defer surgery and monitor

    • B. 

      Laparoscopic hernia repair

    • C. 

      Open surgical hernia repair

    • D. 

      Prescribe a hernia truss

  • 12. 
    A 67-year-old woman is admitted to the hospital with endocarditis. Two weeks ago, she was discharged from the same hospital, where she was treated for heart failure. During the previous admission, an echocardiogram revealed “mild calcific mitral stenosis with a mobile vegetation on the anterior leaflet.” In the patient’s chart from the index hospitalization, the attending physician made no mention of the mobile component on the leaflet in his notes. Two days prior to the patient’s discharge, he signed off the case and transferred care to another attending physician, who completed the hospitalization and discharge without noting the abnormal echocardiogram. During that admission, two subspecialty consultants and three trainees all had access to the echocardiogram report, but none had noted the abnormal report. The original attending physician explained that the echocardiogram report had been communicated to him by a physician assistant, and he had not read the actual report. Which of the following quality improvement tools will be most helpful in analyzing the reason the echocardiogram report was missed?
    • A. 

      Chart audit

    • B. 

      Root-cause analysis

    • C. 

      Standardized protocols

    • D. 

      Team "time out"

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