NMS Q&A Family Medicine

90 NMS Q&A Family Medicine3 Which of the following colorectal cancer screeningrecommendations would be acceptable for a 35-yearoldwoman whose father had colon cancer at the ageof 55 years and an older brother who had 6 adenomatouspolyps discovered on routine dual contrastbarium enema (DCBE) at the age of 48 years?(A) Colonoscopy beginning now and every10 years(B) Colonoscopy starting at age 40 and every5 years thereafter(C) Flexible sigmoidoscopy every 5 years; considercolonoscopy if positive(D) Fecal occult blood test annually, followed bycolonoscopy or DCBE if positive(E) DCBE now and every 5 years; considercolonoscopy if positive4 A 38-year-old woman has complained of abdominalpain and variably changing bowel habits consistingof cramps, bloating, and diarrhea alternating onoccasion with constipation (lack of bowel movementsfor a day or so) for about 5 years. There are nospecific foods that seem to be associated with eitherdiarrhea or constipation. Between bouts, stool arewell formed and of normal size. She has not lostweight and her height and weight are as expected,given her parents’ anthropometrics. She has no familyhistory of colorectal cancer; flexible sigmoidoscopyand later colonoscopy, indicated on the basis ofher lower bowel symptoms, have been negative ontwo occasions. Which of the following regimens isthe most likely to provide relief from the diarrhea,constipation, and abdominal pain?(A) Hyoscyamine (Levsin)(B) Tricyclic antidepressants, for example,amitriptyline(C) Alosetron (Lotronex)(D) Loperamide (Imodium)(E) Serum serotonin reuptake inhibitor (fluoxetine,Prozac; paroxetine, Paxil)5 Which of the following parasite is capable of causingintestinal malabsorption?(A) Enterobius vermicularis(B) Giardia lamblia(C) Ancylostoma duodenale(D) Necator americanus(E) Entamoeba histolytica6 A 75-year-old white woman with presumptive recurrentpneumonia was readmitted to the hospital whereshe had been kept for 2 weeks as a result of her prolongedcourse. She had been discharged on levofloxacin.After a period of recovery, she began to have feveragain plus weakness, dyspnea, and watery diarrhea withmucus. Upon readmission, she was placed on moxifloxinand doxycycline, based on x-ray findings ofpneumonia. A complete blood count showed a leukocytosislevel greater than that which had been found onthe previous admission, 30,000/mm 3 with a neutrophiliaand a left shift toward young cells (band nuclei).Which of the following is the likely cause of her illness?(A) Recurrent pneumonia(B) Irritable bowel syndrome (IBS)(C) Pseudomembranous colitis(D) Carcinoma of the descending colon(E) Ulcerative colitis7 Which of the following is the best choice of therapeuticagents among those presented for the treatment ofpseudomembranous colitis?(A) Clindamycin(B) Third-generation cephalosporin(C) Amoxicillin-clavulanate(D) Metronidazole(E) DoxycyclineFor Questions 8 through 12, match the numbered causes ofoccult gastrointestinal (GI) bleeding with the lettered settingsin which the cause is most likely to be found.8 Carcinoma of the colon9 Vascular ectasia (angiodysplasia)10 Blue rubber bleb nevus syndrome11 Celiac sprue12 Kaposi sarcoma, cytomegalovirus colitis(A) Chronic renal failure(B) Cutaneous hemangiomas(C) Chronic diarrhea, abdominal pain(D) Age 50 years(E) Acquired immunodeficiency diseaseFor Questions 13 through 17, match the numbered conditionscommonly associated with nausea and the lettered recommendedpharmacologic agents or combinations for treatmentthereof.13 Migraine headache14 Vestibular nausea15 Pregnancy-induced nausea16 Gastroenteritis