NMS Q&A Family Medicine

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164 NMS Q&A Family Medicine7 For a patient with diagnosed RA, you consider startinga disease modifying drug (DMARD) based on thebelief that early use of DMARD results in delayedprogression of bone erosion compared to delayedtreatment. Each of the following is an example of aDMARD except which one?(A) Azathioprine Methotrexate 2e(B) Hydroxychloroquine Antimalarials(C) Auranofin Intramuscular gold 2e(D) Cox-2 inhibiting NSAIDs(E) Etanercept8 A 45–year-old man has complained of low back pain,worse in the morning and occasionally during thenights, gradually increasing over the past 3 months.Three days ago, he began to have discomfort in the lefteye, which upon entering the office appears red and thepatient is squinting in the lights of the examining room.There are no gastrointestinal complaints nor skinlesions. Stain of the cornea with fluorescein is negativefor disruption of the epithelium. The pupil in the left(affected) eye is smaller than that of the right. You drawblood tests and find that the patient’s human leukocyteantigen (HLA) is type B27. Which of the following testsor signs is likely to be positive/present?(A) Plantar reflex(B) Murphy sign(C) Schirmer test(D) Rovsing sign(E) Schober test9 A 48-year-old man who has been diagnosed withankylosing spondylitis now complains of left footpain. In what part of the foot is the most likely localefor this pain to appear?(A) Retrocalcaneal(B) First metatarsal(C) Between the first and second metarsals(D) Across the dorsum of the forefoot(E) Supracalcaneal10 You are examining a 12-year-old male patient with ahistory of arthralgias. Upon examination, you notethat the skin is easily stretched and has a dry, rubberyfeel. The patient’s mother asks him to demonstratethat he can place his hand flat on the examining table,then lift it, and rotate it painlessly 360 degrees andplace it back flat on the table. Which of the followingis the most likely diagnosis?(A) Congenital dislocation of the shoulder(B) Ehlers–Danlos syndrome(C) Polymyositis(D) Fibromyalgia(E) RA11 A 45-year-old white woman complains of pain on thesole of the foot. It has been present for several weeks,is worse in the mornings for several minutes, andtends to subside when the patient walks significantdistances; it is aggravated by walking upstairs. Whichof the following is the likely diagnosis?(A) Calcaneal epiphysitis(B) Lumbar radiculopathy(C) Osteomalacia(D) Claudication of the foot(E) Plantar fasciitis12 Which of the following statements regarding fibromyalgia(fibrositis) is correct?(A) In its pure form, NSAIDs are often of benefit.(B) Affected patients usually have decreaseddelta-wave sleep on sleep studies.(C) Affected patients have evidence of neuropathyon nerve conduction studies that is consistentwith the paresthesias they report.(D) Sedimentation rates and C-reactive protein levelsare elevated.(E) Patients demonstrate diffuse joint effusion.13 A 60-year-old man complains of right hip pain,which has progressed over the past 5 years. Therehave been no recent falls or trauma. He used to playhalfback in football during his high school and collegedays. He is afebrile and has no visible joint deformitieson examination. You note poor right hipabduction and slight pain to palpation. You believehe may have osteoarthritis of his right hip. Which ofthe following statements regarding osteoarthritis iscorrect?(A) Women tend to have fewer joints involvedthan men.(B) Patients typically complain of 1 to 2 hours ofmorning stiffness.(C) It is more likely to be seen if significant traumahas occurred to the affected joint.(D) There is usually pain only on active range ofmotion of the involved joint.(E) It is always symptomatic with pain, crepitus,and stiffness.14 After being started on hydrochlorothiazide, a 60-year-oldman complains of bouts of intense pain at the great toeMTP joint, and you suspect gout. Which of the followingwould have to be true for you to confirm this diagnosiswith certainty?(A) The pain is located in the first MTP joint.(B) The patient has an elevated serum uric acid level.(C) The patient has an erythematous, painful jointassociated with a fever and serum leukocytosis.
Rheumatology in Primary Care 165(D) A 24-hour urine uric acid level is 800 mg/dL.(E) Aspirated joint fluid shows negatively birefringent,needle-shaped crystals within WBCs when viewedwith a polarizing microscope.15 Which of the following is correct with respect to calciumpyrophosphate deposition disease (CPDD, alsoknown as pseudogout)?(A) Its incidence is increased with advanced patientage.(B) The crystals are easier to detect in this diseasethan in gout.(C) It may be associated with hypoparathyroidism.(D) It typically affects only the weight-bearingjoints.(E) Attacks are always monoarticular.18 Plantar fascia rupture19 Posterior tibial tendonitis20 Retrocalcaneal bursitis(A) Pain is retrocalcaneal.(B) Pain is in the inside of the foot and the ankle.(C) There is an intense tearing sensation on thebottom of the foot.(D) There is a history of trauma.(E) Pain is in the area of a thinned plantar aspect ofthe heel.For Questions 16 through 20, match the numbered soft tissuecauses of heel pain with the lettered descriptions of clinicalpresentations.16 Fat pad atrophy17 Heel contusion
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NMS Q&AFamily Medicine3rd EDITION
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Acquisitions Editor: Susan RhynerPr
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Foreword to the First EditionFamily
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AcknowledgmentsFor the contribution
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xivContentsChapter 15 Surgical Issu
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SECTION IUrgent Carechapter 1Urgent
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Urgent Care in Family Practice 3(A)
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Urgent Care in Family Practice 5Exa
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Urgent Care in Family Practice 7rem
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10 NMS Q&A Family Medicine(A) To pl
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12 NMS Q&A Family MedicineExaminati
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chapter 3Otolaryngology inPrimary C
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Otolaryngology in Primary Care 17tr
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Otolaryngology in Primary Care 1924
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Otolaryngology in Primary Care 21of
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Otolaryngology in Primary Care 23co
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26 NMS Q&A Family Medicine(A) Migra
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30 NMS Q&A Family MedicineQuestions
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32 NMS Q&A Family Medicine(A) Distu
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36 NMS Q&A Family Medicine80 mm Hg.
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SECTION IIICardiovascular Diseasesi
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Cardiology 41(A) Systolic crescendo
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Cardiology 43Examination Answers1.
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Cardiology 4516. The answer is C. T
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chapter 7Peripheral Vascular Diseas
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Peripheral Vascular Disease 49would
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Peripheral Vascular Disease 51Exami
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Peripheral Vascular Disease 53right
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chap ter 8Cerebrovascular DiseaseEx
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Cerebrovascular Disease 57(A) A non
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Cerebrovascular Disease 59ventricul
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chap ter 9Pediatric CardiologyExami
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Pediatric Cardiology 6315 You hear
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Pediatric Cardiology 65by placing o
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chap ter 10HypertensionExamination
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Hypertension 6915 In hypertensive p
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Hypertension 71systolic hypertensio
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74 NMS Q&A Family Medicine(A) Right
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Neurology 778. The answer is A. The
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SECTION VRespiratory Diseasesin Pri
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Pneumonia and Bronchitides 81(C) Co
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Pneumonia and Bronchitides 836. The
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chapter 13Respiratory Diseasesin Ch
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Respiratory Diseases in Children 87
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SECTION VIThe Gastrointestinal Trac
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Medical Problems of the Gastrointes
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Medical Problems of the Gastrointes
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chap ter 15Surgical Issues of theGa
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Surgical Issues of the Gastrointest
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Surgical Issues of the Gastrointest
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chap ter 16Problems of the LiverExa
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Problems of the Liver 103level, whe
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Problems of the Liver 105been inves
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SECTION VIIUrology and Nephrologyin
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Problems of the Urinary Tract 10913
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Problems of the Urinary Tract 11110
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Page 149 and 150: chapter 21Gynecology in Mature Adul
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Page 207 and 208: chap ter 31Other Infectious Disease
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Page 213 and 214: SECTION XIEndocrinology inPrimary C
Page 215 and 216: Diabetes Mellitus 197normal saline
Page 217 and 218: Diabetes Mellitus 199Examination An
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216 NMS Q&A Family Medicine(A) Prad
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218 NMS Q&A Family MedicineExaminat
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SECTION XIIAllergieschapter 36Atopi
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Atopic, Food, and Contact Allergies
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Atopic, Food, and Contact Allergies
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SECTION XIIIPreventive HealthCarech
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Preoperative Clearance 229180 to 22
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Preoperative Clearance 23121 Prophy
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Preoperative Clearance 233example,
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chap ter 38Obesity and Dyslipidemia
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Obesity and Dyslipidemia 23713 A 45
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Obesity and Dyslipidemia 239attriti
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chapter 39Smoking CessationExaminat
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Smoking Cessation 243Examination An
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chapter 40Exercise and HealthExamin
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Exercise and Health 247Examination
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chapter 41Concepts in Epidemiologya
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Concepts in Epidemiology and Resear
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Concepts in Epidemiology and Resear
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256 NMS Q&A Family Medicine7 What i
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258 NMS Q&A Family Medicineantigen
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260 NMS Q&A Family Medicine(B) Arra
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262 NMS Q&A Family Medicineinfectio
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264 NMS Q&A Family Medicine(D) Pulm
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266 NMS Q&A Family Medicinemay occu
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268 NMS Q&A Family Medicinebeing se
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270 NMS Q&A Family Medicineis exace
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272 NMS Q&A Family Medicine8 What a
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274 NMS Q&A Family Medicine12. Hepa
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276 NMS Q&A Family Medicine(D) Ever
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278 NMS Q&A Family MedicineAlthough
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280 NMS Q&A Family Medicine5 Of the
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282 NMS Q&A Family Medicineclinicia
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284 NMS Q&A Family Medicine9 Regard
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288 NMS Q&A Family Medicinedenied a
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290 NMS Q&A Family Medicinewithout
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chapter 51Anxiety and PhobiasExamin
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Anxiety and Phobias 297Examination
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chapter 52Somatic Symptoms withoutO
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Somatic Symptoms without Organic Ba
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Somatic Symptoms without Organic Ba
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306 NMS Q&A Family Medicine5 A 25-y
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308 NMS Q&A Family Medicineperiorbi
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310 NMS Q&A Family Medicineand loti
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chapter 54GeriatricsExamination que
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Geriatrics 315Examination Answers1.
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chapter 55HematologyExamination que
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Hematology 31915 A 45-year-old busy
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Hematology 321Mean cell hemoglobin
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Hematology 323whereas in multiple m
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