NMS Q&A Family Medicine

102 NMS Q&A Family Medicine(D) There need be no particular protective measuresfor her fiancée.(E) The fiancée should take a course of an immunemodulator such as recombinant alfa-2b(Intron A).7 A 56-year-old male patient who had transfusions20 years ago and contracted hepatitis C comes to youas a new patient. During your examination, you noticedilated flank veins, redness of the palms, and suspicionof ascites. From a computed tomography scan,you find ascites and conclude that the patient has cirrhosis.Knowing that hepatitis C is a strong risk factorfor hepatocellular carcinoma, stronger even thanhepatitis B, you decide to begin with a screeningbaseline test for that disease. Which of the followingtests serves that purpose?(A) Carcinoembryonic antigen test(B) Alpha-fetoprotein test(C) Breast cancer 1, early onset (BRCA1) genetic test(D) Human chorionic gonadotropin test(E) Prostate-specific antigen test8 A 45-year-old white man has undergone a routine periodicphysical examination. You note that, for the past 3years, each hepatic profile testing ordered by your officehas shown ALT and AST elevations of up to two tothree times normal levels. You decide to investigate instepwise fashion. Each of the following steps would beappropriate at this time, except for which one?(A) Inquire as to drinking habits(B) Inquire as to intravenous street drug usage(C) Complete review of the patient’s medications(D) Order an ultrasound study of the liver(E) Order serologic tests for hepatitides A, B, and Cand blood tests for iron studies9 A 35-year-old woman who has had two pregnanciesand is 20% overweight presents with jaundice. Serumconjugated bilirubin level is elevated to twice theupper limit of normal. Unconjugated bilirubin isnormal. Which of the following, as a single procedure,is most likely to elucidate a cause of this clinicalsituation?(A) Blood draw for hepatitides A, B, and C(B) Computed tomography scan of the liver(C) Ultrasound study of the extrahepatic biliarysystem(D) Plain x-ray of the abdomen(E) Blood draw for ALT and AST10 A 46-year-old woman is evaluated for worseningfatigue and pruritus that have been present for atleast 8 years. Abdominal pain has not been a majorsymptom. Recently, she has complained of diarrheawith stools that float in the commode. She drinks twoto three glasses of wine weekly. On examination, youfind xanthomas on the extensor surfaces of the forearms.She also manifests xanthelasmas on the eyelids.There are dilated flank veins on each side of thetrunkal area. There is no mass palpable. The comprehensivemetabolic profile shows alkaline phosphataseelevated to twice the upper limit of normal, anddirect-acting (conjugated) bilirubin is elevated to1.5 times the upper limit of normal. The lipid profilereveals elevated cholesterol to 280 mg/dL and highdensitylipoprotein cholesterol at 70 mg/dL. Which ofthe following is the most likely diagnosis?(A) Choledocholithiasis(B) Gilbert disease(C) Carcinoma of the head of the pancreas(D) Primary biliary cirrhosis (PBC)(E) Alcoholic cirrhosis11 Which of the following is the most easily passed by ablood donor?(A) Hepatitis A(B) Hepatitis B(C) Hepatitis C(D) Hepatitis D(E) Hepatitis E12 Your patient is a 55-year-old male professor of languageat the nearby university. He has been stable inhis professional life and as a marital partner and adequatelyso as a parent. He appears for periodic healthprofile evaluation. A routine chemistry batteryreturns with surprise findings of mean cell volume inan otherwise normal hemogram of 97 m 3 (also97 fL); gamma-glutamyl transpeptidase 255 U/L (normalis 5 to 40 U/L); serum AST 199 U/L (formerlySGOT, 1 to 36); ALT 101 (formerly SGPT, 1 to 45);and blood urea nitrogen (BUN) 6 mg/dL. Alkalinephosphatase is normal at 75 U/L. Bilirubin levels,conjugated and unconjugated, are normal. Whatshould be your next measure?(A) Order gallbladder ultrasound study(B) Arrange a liver biopsy(C) Arrange an esophagogastroduodenoscopy(D) Order hepatitis profile (tests of antigens andantibodies of hepatitides A, B, and C)(E) Obtain further information through themedical interview of the patient13 A 30-year-old white man with a history of ulcerativecolitis develops obstructive jaundice, associated withfever. There has been no colicky pain and very littleabdominal pain in general. A gallbladder ultrasoundstudy is negative for gallstones. The direct-acting bilirubinlevel is elevated, as is the alkaline phosphatase