NMS Q&A Family Medicine

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174 NMS Q&A Family Medicinenodules. Which of the following is least likely in thedifferential diagnosis?(A) Pulmonary tuberculosis(B) Histoplasmosis(C) Hypersensitivity pneumonitis(D) Pneumococcal pneumonia(E) Sarcoidosis7 The patient in Question 6 began to feel significantlybetter and has been followed for several more weeks.A tuberculosis skin test, repeated after 2 weeks, wasnegative. The serum calcium is elevated slightly, andin a bronchial lavage specimen, the ratio of CD4 toCD8 lymphocytes is 4.0. Now she complains of painfulred nodules on her lower legs. Which of the followingis the most likely diagnosis?(A) Pulmonary tuberculosis(B) Histoplasmosis(C) Hypersensitivity pneumonitis(D) Acquired immunodeficiency syndrome (AIDS)(E) Sarcoidosis8 A 35-year-old African-American woman has complainedof weight loss and fatigue for several weeks. Inadvising her on the phone as to measures to take beforeher appointment with you the following week, youasked her to keep a record of her temperature 4 timesper day. She arrives for the appointment with the record.She also notes diffusely thinning hair. The temperaturegraph shows that her temperature has sometimes beenas high as 101 F. However, the high points of the dailygraphs appear at various times in the early hours of themorning or late mornings, not in the afternoons or evenings.She complains also of arthralgia involving hermetacarpophalangeal joints of the first and second fingersbilaterally, with 30 to 60 minutes of stiffness in themorning. A urinalysis yields microscopic hematuriaand red cell casts. Which of the following diagnoses ismost likely, given the combination of clinical findings?(A) Chronic glomerulonephritis(B) Alopecia areata(C) LE(D) Chronic pyelonephritis(E) Pulmonary tuberculosis9 A 35-year-old white woman has had two bouts ofpleurisy and a bout of pericarditis, none associatedwith infection, within 3 months. In addition, shemanifests a hemolytic anemia with reticulocytosisand leukopenia (3,500 white blood cells/mm 3 ) ontwo occasions. You suspect a connective tissue diseaseand order an ANA test. The result is positive for thehomogeneous pattern. Which of the following is thebest conclusion to draw from that result?(A) The patient has SLE.(B) The patient could have a connective tissuedisease or drug-induced SLE.(C) The patient has had undiagnosed pneumonia.(D) The patient should be evaluated formesothelioma.(E) The patient has a blood dyscrasia.10 Each of the following is characteristic of scleroderma,except for which one?(A) Polyarthralgia(B) Raynaud phenomenon(C) Intestinal malabsorption(D) Positive test for Sm antibodies(E) Pulmonary hypertension11 A 45-year-old woman complains of difficulty initiatingswallowing and increasingly early onset of fatigueof her legs as she climbs stairs and in her arms as shelifts baskets of laundry. She notices skin changes thatyou see consist of violaceous coloration about theeyes and in the periungual areas that also are manifestedover the shoulders and anterior chest. Younotice also clubbing of her nails and that she has acough that she relates to her smoking. Which of thefollowing accounts for her systemic symptoms andrash?(A) Photosensitivity eruption(B) Contact dermatitis(C) Polymyositis(D) Dermatomyositis(E) SLE12 Regarding the patient in Question 11, which of thefollowing most likely accounts for the nail clubbing?(A) Chronic obstructive pulmonary disease(B) Reversal of left-to-right shunt through aninterventricular septal defect (the Eisenmengersyndrome)(C) Hepatic cirrhosis(D) Congenital variant(E) Lung cancer13 A 25-year-old man complains of prolonged upperrespiratory congestion. You have treated him forsinusitis twice and for otitis media over the past year,although these are the first such occasions he has hadthese problems in his adult life. This week, he complainsof redness of the eyes with vascular ectasia thatdoes not move over the sclera the way one notes theconjunctival movement with changes in gaze. Bloodpressure levels are normal. You consult by telephoneyour favorite rheumatologist, who suggests orderinga number of antibody levels. Their results are as follows:ANA, anti-Sm, SS-A, SS-B, and anticentromere,
Connective Tissue Diseases 175all negative; rheumatoid factor and antineutrophilcytoplasmic antibody (ANCA) positive. Which of thefollowing is the most likely condition to account forthe symptomatology?(A) Wegener granulomatosis(B) SLE(C) Dermatomyositis(D) Systemic sclerosis(E) Rheumatoid arthritisFor Questions 14 through 18, match the numbered clinicalcharacteristics with the lettered diseases.16 Proximal muscle weakness and difficulty in initiationof swallowing17 Pleural and pericardial effusions18 Heliotrope rash about the eyes(A) Sarcoidosis(B) Sjögren syndrome(C) Polymyositis(D) SLE(E) Dermatomyositis14 Formation of sialoliths (salivary duct stones)15 Nephrocalcinosis
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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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114 NMS Q&A Family Medicine7 Which
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116 NMS Q&A Family MedicineExaminat
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118 NMS Q&A Family Medicineof malig
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120 NMS Q&A Family Medicine(D) Sulf
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Page 149 and 150: chapter 21Gynecology in Mature Adul
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Page 155 and 156: chapter 22Diseases of the Female Br
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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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Page 241 and 242: 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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326 NMS Q&A Family Medicine7 A 45-y
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