NMS Q&A Family Medicine

96 NMS Q&A Family Medicineappendicitis. Pelvic examination reveals right adnexalarea tenderness but no cervical tenderness Whichof the following may be most helpful in determiningwhether the patient has appendicitis, thus makingit less likely for you to commit to unnecessarysurgery or missing timely intervention in the event ofappendicitis?(A) Abdominal plain films(B) Helical computed tomography (CT) scan of theabdomen(C) CT scan(D) Ultrasonography(E) Magnetic resonance image8 A 40-year-old white man has been treated for pepticulcer disease (PUD) symptoms for several weeks. Thepatient also has diarrhea, a problem he had not hadin the past. He denies taking nonsteroidal antiinflammatorymedication either by prescription or overthe counter. You treated the patient with a 3-weekcourse of the histamine 2 receptor blocking agent (H2receptor blocker) ranitidine, but the patient’s symptomsonly slightly improved and recurred fully withindays after discontinuance of the drug. You then prescribedthe hydrogen pump blocking agent omeprazolefor 3 weeks with similar disappointing results.Esophagogastroduodenoscopy then demonstrated alarge ulcer (3-cm diameter) distal to the duodenalbulb. During the procedure, studies were done forH . pylori that were negative. Which of the followingwould be the next logical action?(A) Draw blood for a gastrin level(B) Refer for lower endoscopy to rule out ulcerativecolitis(C) Order barium upper GI series with smallbowel follow-through to rule out Crohndisease(D) Order stool cultures for bacterial cause ofinfectious diarrhea(E) Order stool studies for ova and parasites9 A 55-year-old man is alcoholic and has an episodeof bleeding esophageal varices. The patient isimpressed with your warnings regarding the dangersof alcoholism and vows to visit a local AlcoholicsAnonymous chapter and to stop drinking alcohol.Which of the following is a valid medical approachto reduce the chances of repeat bleeding episodes,thus avoiding surgical emergencies caused by hemorrhage?(A) Calcium channel blocking agent(B) Beta-selective agonist agent(C) H2 receptor blocker(D) Nonselective beta-adrenergic blocking agent(E) Proton pump blocker10 A 70-year-old white woman is found to have a hemoglobinlevel of 4 g/100 mL and a macrocytosis. Serumvitamin B 12 level is abnormally low. The patientdenies history of diarrhea. Serum folic acid levels arenormal. As you begin treatment of this patient, whichof the following procedures comes under the headingof “best practice”?(A) Barium enema(B) Barium swallow with small bowel followthrough(C) Upper GI barium series(D) Colonoscopy(E) Upper endoscopy11 Which of the following sites of colon cancer, uponpresentation of symptoms and signs, confers the mostfavorable prognosis?(A) Cecum(B) Ascending colon(C) Transverse colon(D) Iliocolic junction(E) Sigmoid colon12 A 35-year-old white man has had abdominal pain forthe past 36 hours. Examination of the anterior aspectof the abdomen is negative for rebound tenderness,although there is some deep tenderness in the midlinebelow the umbilicus. The WBC count is elevatedto 19,000 with 80% neutrophils, of which 30% arebands. Which of the following would be helpful inestablishing a diagnosis of retrocecal appendicitis?(A) Babinski response(B) Obturator sign(C) Rovsig sign(D) Murphy sign(E) Osler sign13 A male newborn who is 4 weeks old has begun tovomit over the past 2 days after each feeding, and thevomit is blood streaked. Last evening the vomitingbecame projectile. You notice a peristaltic wave in theupper abdomen moving from left to right. Deep palpationbetween attacks reveals an olive-sized nodulein the epigastrium. Which of the following is the likelydiagnosis?(A) Acute gastritis(B) Iliocolic intussusception(C) Pyloric stenosis(D) Esophageal atresia(E) Pneumonia14 An 11-month-old male infant develops apparent colickyabdominal pain, as he screams and draws up hisknees with each bout of pain. Within 12 hours thechild exhibits vomiting and diarrhea consisting of